Sydenham Chorea and PANDAS in South Africa: Review of Evidence and Recommendations for Management in Resource-Poor Countries

In South Africa, and worldwide, rheumatic fever represents a public health problem. Improved diagnosis and management of Sydenham chorea, a major manifestation of acute rheumatic fever is key to prevention of rheumatic heart disease. This article reviews Sydenham chorea from its original description...

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Bibliographic Details
Published in:Journal of child neurology 2015-06, Vol.30 (7), p.850-859
Main Authors: Walker, Kathleen G., de Vries, Petrus J., Stein, Dan J., Wilmshurst, Jo M.
Format: Article
Language:English
Subjects:
Autoimmune Diseases of the Nervous System - diagnosis
Autoimmune Diseases of the Nervous System - epidemiology
Autoimmune Diseases of the Nervous System - pathology
Autoimmune Diseases of the Nervous System - therapy
Chorea - diagnosis
Chorea - epidemiology
Chorea - pathology
Chorea - therapy
Humans
Neurodevelopmental Disorders - diagnosis
Neurodevelopmental Disorders - epidemiology
Neurodevelopmental Disorders - pathology
Neurodevelopmental Disorders - therapy
Rheumatic Fever - diagnosis
Rheumatic Fever - epidemiology
Rheumatic Fever - pathology
Rheumatic Fever - therapy
South Africa
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Summary:In South Africa, and worldwide, rheumatic fever represents a public health problem. Improved diagnosis and management of Sydenham chorea, a major manifestation of acute rheumatic fever is key to prevention of rheumatic heart disease. This article reviews Sydenham chorea from its original description to current opinions. Recommendations are founded on expert opinion as class 1 data is lacking. This South African perspective is relevant to resource-poor settings globally insofar as it provides diagnosis and management recommendations for primary- and secondary-level healthcare professionals who care for patients in such environments. Four basic tenets of care are recommended, namely, elimination of the streptococcal infection, symptomatic treatment, immunological treatment, and nonpharmacologic interventions. A user-friendly outcome measurement tool, viable for use in low-resource settings is presented. Introduction of this tool may lead to increased awareness of the neuropsychiatric manifestations of poststreptococcal movement disorders in Africa, where reports are limited.
ISSN:0883-0738
1708-8283
DOI:10.1177/0883073814544704