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Cardiovascular Journal of Africa • ABSTRACTS – SA HEART
®
CONGRESS 2019
S5
AFRICA
A descriptive study of adult mitral valve disease at a tertiary referral centre
Ebrahim Banderker*, Merika Tsitsi
#
and Ruchika Meel
#
*Gauteng Department of Health, Johannesburg, South Africa.
#
Chris Hani Baragwanath Academic Hospital, University of the Witwatersrand, Johannesburg,
South Africa
Introduction:
There is limited literature regarding the current clinical characteristics of patients with mitral valve disease (MVD). Therefore, this study aimed
to systematically document the clinical and demographic characteristics of patients with MVD.
Methods:
This was a cross-sectional descriptive sub-study to a larger ongoing study on valvular heart disease (VHD) at the Chris Hani Baragwanath Academic
Hospital (CHBAH) valve clinic. All data were extracted from clinic files and a preliminary analysis of data regarding patients with MVD was performed.
Results:
The study comprised 134 patients with MVD. The mean age was 50 ± 13.3 years with 77% being females. The majority were of African ethnicity
(96%). Most patients were in New York Heart Association functional class II (54%). The predominant mitral valve lesion was mitral regurgitation (39%) followed
by mixed mitral valve disease (38%) and mitral stenosis (23%). The main aetiology of MVD was rheumatic heart disease (80%), mitral valve prolapse was noted
in 11%, myxomatous and degenerative disease was present in 5%. Infective endocarditis was noted in 3%. Severe MVD was present in 51% of patients. Thirty
percent of the patients had concomitant involvement of other valves. The main co-morbidities were hypertension (30%) and HIV (12%). The main reason for
initial hospitalisation was heart failure (78%). Twenty two percent had recurrent admission for heart failure (HF). Ninety four percent of patients were on HF
treatment. Fourteen patients were on rheumatic fever prophylaxis. None of the patients presented for surgery had coronary artery disease (75%). MVD was
complicated with pulmonary hypertension (28%) and atrial fibrillation (14%) in 57 patients.
Conclusion:
Mitral valve disease is common at CHBAH. The current patients tend to be older females with co-morbidities. The majority of patients presented
in HF. The predominant aetiology was chronic rheumatic heart disease and acute rheumatic fever was rare.
Molecular typing of non-invasive group A streptococcal infection at Groote Schuur Hospital, Cape Town
Dylan Barth*, Preneshni Naicker
#
, Kelin Engel
#
, Babu Muhamed
#
, Bongani Mayosi
#
, Jim Dale
†
and Mark Engel
#
*Telethon Kids Institute, Perth Children’s Hospital, Perth, Australia.
#
Department of Medicine, Groote Schuur Hospital and University of Cape Town,
Observatory, South Africa.
†
University of Tennessee, Tennessee, United States of America
Introduction:
Group A streptococcus (GAS) is responsible for a wide range of non-invasive (non-iGAS) and invasive group A streptococcal (iGAS) infections
and continues to be a major cause of premature death and morbidity. Primary prevention strategies have focused on the development of a vaccine; the most
advanced being a 30-valent vaccine. We aimed to describe the molecular characteristics of iGAS isolates, particularly in respect to how they compare and
contrast with non-iGAS isolates. We also sought to investigate the potential coverage from the putative M-protein vaccine.
Methods:
We conducted a prospective passive surveillance laboratory study, from February 2016 - March 2017, amongst samples submitted to the National
Health Laboratory Service (NHLS) from patients attending public health facilities in Cape Town. We documented demographic data, clinical presentation,
laboratory data and emm types which cause non-iGAS and iGAS infections. The study was approved by the UCT HREC (R006/2015).
Results:
GAS was commonly isolated from pus swabs, blood, deep tissue and aspirates. Common clinical presentations included: wound infections
(20%), bacteraemia (15%), abscesses (9%) and septic arthritis (8%). Two-hundred and thirty-three isolates were available for emm typing, from which 46
different emm types were identified. The most prevalent emm types were: M76 (16% of isolates), M81 (10%), M80 (6%), M43 (6%) and M183 (6%) and these
were almost evenly distributed between non-iGAS and iGAS isolates. Vaccine coverage for non-iGAS and iGAS infection in our setting was 60% and 59%
respectively, notably lower than coverage in developed countries. Four of the most prevalent emm types are not included.
Conclusion:
Emm-types from GAS isolated from patients with iGAS did not differ significantly from those isolated from non-iGAS cases. Furthermore, this
research indicates a potentially low coverage of the M-protein vaccine in our setting and emphasises the need for a reworking of the potential vaccine
formulation to improve coverage in high burden settings.
The missing piece study: A surveillance study for Strep A pharyngitis and Impetigo in the Kimberley, Australia
Dylan Barth*, Neomie Dickerson*, Robyn Macarthur
#
, Coco Chou†, Marianne Mullane*, Jonathan Carapetis* and Asha Bowen*
*Telethon Kids Institute, Perth Children’s Hospital, Perth, Australia.
#
Derby Aboriginal Health Service, Derby, Western Australia. †Princeton University, New
Jersey, United States of America.
Introduction:
Acute rheumatic fever (ARF) is the most common cause of acquired heart disease in childhood. Although a causal pathogenic pathway
has been confirmed between pharyngitis and subsequent ARF, a plausible link has been proposed between Strep A Impetigo and ARF. This hypothesis is
supported by high rates of ARF in Australian Aboriginal populations where Impetigo is endemic and Strep A pharyngitis rare. A key piece of missing evidence
is the documentation that Strep A pharyngitis is truly rare. We aimed to evaluate the concurrent burden of Strep A pharyngitis and Impetigo in Aboriginal
children (5 - 15 years) in the Kimberley, Western Australia.
Methods:
This school-based study in 2 remote schools is designed to collect clinical, serological, microbiological and molecular data on Strep A pharyngitis
and Impetigo in Australia. This study comprised 2 components: (a) Screening the entire consented population 3 times per year and (b) weekly surveillance
for symptomatic pharyngitis and Impetigo. Surveillance included: a history, clinical examination, photographs, swabs and a dried blood spot specimen for
Anti-Streptolysin O titres (ASOT). All swabs were cultured for isolate identification, followed by characterisation of the molecular epidemiology using whole
genome sequencing (WGS) to determine the vaccine coverage of the 30-valent vaccine formulation. Preliminary results are reported from screening visit 1.
Results:
We enrolled 124 children; 76 male (61%) and 62 (50%) identified as Aboriginal. The prevalence of sore throat and skin sores were 10% (n=13) and
27% (n=33), respectively. Fifty one percent (n=52) of the children had an ASOT reading of >200 IU. Throat swabs (n=118) and skin swabs (n=39) will undergo
laboratory and molecular evaluations.
Conclusion:
This work has important implications for guidelines and policies targeting primary prevention of Strep A infections driving high rates of ARF and
RHD in Australian Aboriginal children. We anticipate our sequencing results of Strep A will further contribute to informing vaccine initiatives.