Poster Presentation Lancefield International Symposium for Streptococci and Streptococcal Diseases 2025

Diverse diagnostic and management approaches for acute rheumatic fever in Australia and New Zealand (#53)

Ruwani Peiris 1 , Rachel H Webb 2 3 4 , Julie Bennett 5 6 , Jennifer Yan 1 7 , Joshua R Francis 1 , Bo Remenyi 7 , Florina Chan Mow 2 , Rachel Burgess 8 , Nigel Wilson 3 , Alicia Stanley 3 , Laura Francis 7 , Rhonda Holloway 3 , Roxanne Westbury 3 , Shirley Lawrence 2 , Yolanda Hernandez Gomez 7 , David I BroadHurst 9 , Nicole J Moreland 6 , Reuben McGregor 6 , Caroline Motteram 8 , Glenn Pearson 8 , Mark Mayo 1 , Anna P Ralph 1 7 , Jonathan R Carapetis 8 10
  1. Menzies School of Health Research, Tiwi, NT, Australia
  2. KidzFirst Hospital, Counties Manukau District Health Board, Auckland, New Zealand
  3. Starship Children's Hospital, Auckland, New Zealand
  4. Department of Paediatrics, Child and Youth Health, University of Auckland, Auckland, New Zealand
  5. Department of Public Health, University of Otago, Wellington, New Zealand
  6. Department of Molecular Medicine and Pathology, School of Medical Sciences, University of Auckland, Auckland, New Zealand
  7. Royal Darwin Hospital, Darwin, Australia
  8. The Kids Research Institute Australia, University of Western Australia, Perth, Western Australia, Australia
  9. School of Science, Edith Cowan University, Perth, Western Australia, Australia
  10. Perth Children's Hospital, Perth, Western Australia, Australia

Background

Acute rheumatic fever (ARF) has diverse presentations and treatments. Children diagnosed with ARF need real-world information on what to expect including length of hospitalisation and likelihood of rheumatic heart disease (RHD). We aimed to describe ARF in Australia and New Zealand to answer clinical questions and determine practice differences.

Methods

We analysed clinical data from a multi-site, prospective cohort study ('Searching for a Technology-Driven Acute Rheumatic Fever Test', START) at Royal Darwin Hospital (Australia), Middlemore Hospital, and Starship Children’s Hospital (New Zealand). Patients hospitalised with confirmed ARF, 2018-2021, were eligible. We used descriptive analyses to compare sites and regression analysis to explore associations with length-of-stay.

Findings

We enrolled 143 episodes of ARF among 141 participants, median age 10 years (range 5-23). The commonest ‘phenotype’ was carditis, polyarthritis, fever, and PR prolongation. 61% had carditis. ARF recurrences, RHD, possible/probable ARF and underweight were more commonly diagnosed in Australia. Positive throat Group A Streptococcus culture was more common in New Zealand. Median length-of-stay was 7 days (range 2-66). Factors associated with longer hospitalisation (univariable model) were valve pathology, corticosteroid requirement, enrolment at Starship Children’s Hospital (cardiosurgical quaternary hospital), definite ARF, symptom duration, and higher inflammatory markers. Significant predictors for length-of-stay in the multivariable model were valve disease, corticosteroids, and higher ESR.

Interpretation

This study provides new knowledge on ARF management and highlights international variation in practice. Differing approaches need to be aligned. Meanwhile, locally-specific information can help guide patient expectations after ARF diagnosis.