Introduction
Echocardiography, the gold standard for RHD diagnosis, has limited availability in resource-limited settings. Given that studies suggest that Group A Streptococcus (GAS)-specific antibodies persist in patients with RHD, there is, therefore, value in investigating the potential predictive value of GAS antibodies as a screening tool to aid in identifying at-risk individuals needing referral. This systematic review explores the evidence, from published literature, of the ongoing association, if any, of GAS antibodies in RHD patients versus control participants.
Methods
This systematic review employed the “CoCoPop” framework. We performed a comprehensive database search and selected articles of any design that evaluated antibody levels against GAS-specific antigens in RHD participants compared to controls. Data were extracted using standardized forms, digitized, and analysed in Stata. Risk of bias was assessed using the Newcastle-Ottawa Scale (NOS).
Results
The search yielded 399 articles; of these, ten comprising participants with confirmed RHD met with the inclusion criteria. Studies evaluated titres for M peptides (n=4 studies), Group A Carbohydrate (n=2), SLO (n=2), and DNase B (n=2). Variability in methods, units, and incomplete data (e.g., missing p-values, SEM/SD) precluded a meta-analysis. Nonetheless, data suggest a persistence of GAS-specific antibodies in RHD cases, with notably higher titres observed in cases compared to controls.
Conclusion
This review highlights the persistence of GAS-specific antibodies in RHD patients vs. control participants. However, most studies predated 2000, revealing a need for updated research to confirm their role in more diverse populations, provide further insight to their diagnostic utility.