ABSTRACT
RF results from interaction between the agent (GAS bacteria), a susceptible host and an adverse environment. This disease has virtually disappeared from the western world. The burden of RF and RHD continues to be high in developing countries where vast majority of all patients with RHD live. RF commonly affects children between the ages of 5 and 15 years and is equally common in both sexes. MS secondary to RHD has a female preponderance. Natural history studies published in 1950s and 60s from western countries describe a slow progression of the severity of MS. However, a number of studies from India and other developing countries have reported a much more rapid progression of MS leading to severe or critical MS at a very young age. These children and young adults have disabling symptoms, have severe pulmonary hypertension and require early intervention. MS is also an important cause of maternal morbidity and mortality in India and many developing countries. RF and RHD are preventable diseases. The preventive strategies need to be multipronged but are challenging in those very countries where RF and RHD are rampant.
