Sydenham's chorea - clinical and therapeutic update 320 years down the line

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South African Medical Journal

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University of Cape Town

Post-streptococcal neuropsychiatric movement disorders (PNM) were first described in the Middle Ages, but today more than 300 years later, confusion remains surrounding the terminology, treatment and monitoring of these conditions. Rheumatic fever is currently the major cause of acquired heart disease among children in South Africa.1 The incidence of acute rheumatic fever (ARF) and rheumatic heart disease (RHD) is not declining. Recent figures quote the incidence of rheumatic fever as 0.6 - 0.7/1 000 population in the USA and Japan compared with 15 - 21/1 000 population in Asia and Africa.2 In a study conducted in 1975 in Soweto, South Africa, 12 050 schoolchildren were examined and 19.2/1 000 had rheumatic heart disease.3 A 2002 report from a cardiology workshop highlighted the belief among clinicians that South Africa is currently in the midst of a rheumatic fever epidemic.4,5 Sydenham’s chorea (SC) is a major manifestation of ARF. Accordingly, in the South African context when PNMs are diagnosed, treatment strategies must always include the prevention of RHD.