In resource-limited tropical settings, both impetigo and rheumatic disease are endemic. The major cause of impetigo in these regions is the group A streptococcus and there is a growing body of opinion implicating impetigo in the pathogenesis of rheumatic fever and rheumatic heart disease (RHD). This potentially has major implications for control of these neglected diseases, which account for at least 350  000 deaths worldwide, annually. In this review, we summarize recent advances in the epidemiology of group A streptococcal skin disease and examine evidence for the relationship between group A streptococcal skin disease and rheumatic fever. ; Journal Article ; Research Support, Non-U.S. Gov't ; info:eu-repo/semantics/published