Is Scabies the Key to Rheumatic Heart Disease Prevention? A Systematic Review of the Evidence

Despite the high prevalence of scabies, acute rheumatic fever (ARF) and rheumatic heart disease (RHD) in regions such as Oceania, few studies have addressed the evidence for a causal relationship of scabies with ARF and RHD. In this study, we evaluate the relationship of scabies with GAS and subsequently ARF and RHD, as it could lead to an additional strategy for ARF/RHD prevention. Databases (PubMed, Web of Science and Scopus) were accessed to identify and include studies that investigated the association between scabies, ARF and RHD. Seventy-three articles investigating a potential link between scabies, GAS skin infections and ARF/RHD were included in this review. Most of these studies were from Australasia. Epidemiological and microbiological evidence consistently support the hypothesis that scabies increases the risk of Group A streptococcal (GAS) infection, which, in turn, leads to ARF and RHD. Many studies found shared risk factors and a strong association between scabies and ARF/RHD. The available evidence supports a role of scabies and GAS skin infection in the pathogenesis of ARF/RHD. Large-scale observational studies should be conducted to further define the relationship between these conditions. Based on the evidence presented here, we believe it is likely that improving scabies diagnosis and treatment would reduce the incidence of ARF/RHD.