Letter to the editor

LJ Zühlke¹, ME Engel²¹Western Cape Paediatric Cardiac Services, Red Cross War Memorial Children's Hospital, University of Cape Town, Cape Town, South Africa; ²Department of Medicine, Groote Schuur Hospital and University of Cape Town, Cape Town, South AfricaWe would like to applaud the authors of the article "The worldwide epidemiology of acute rheumatic fever (ARF) and rheumatic heart disease (RHD)"¹ for highlighting this important disease which continues needlessly to kill people living in poverty while being largely ignored by the developed world.² We would however like to address some key issues.The authors state that: the evidence of serologic infection is based on one of "a pharyngeal swab culture positive for GABHS, positive rapid GABHS antigen test or rising serologic antibody titers". Very few countries in highly affected regions of the world utilize routine rapid antigen or microbiological testing due to the cost involved. Furthermore, the delay involved in repeat serological testing before a diagnosis can be made, will result in missed diagnoses and tragic consequences. We recommend therefore that elevated serological markers of previous GABHS infection, together with major and minor criteria, are sufficient for a diagnosis of ARF.