Acute Rheumatic Fever

Abstract

The incidence of acute rheumatic fever (ARF) is 8 to 51 per 100,000 people worldwide. It most commonly affects children 5 to 15 years of age after a group A streptococcal infection. Overcrowding and poor socioeconomic conditions are directly proportional to the incidence of ARF. Rheumatic carditis is a manifestation of ARF that may lead to rheumatic heart disease (RHD). Timely treatment of group A streptococcal infection can prevent ARF, and penicillin prophylaxis can prevent recurrence of ARF. Prevention of recurrent ARF is the most effective way to prevent RHD. ARF is diagnosed using the 2015 modified Jones criteria. There is no gold standard laboratory test. Therefore, clinicians need to be aware of the clinical signs and symptoms of ARF to include in their differential diagnosis when seeing such patients. Secondary prophylaxis with benzathine penicillin G has been shown to decrease the incidence of RHD and is key to RHD control. Clinicians need to understand the implications of secondary prophylaxis for ARF. There is also a need to improve ARF diagnosis, to find novel therapies to reduce the incidence of ARF, and to reduce the prevalence of RHD. RHD research is neglected and underfunded. Thus, there is also a need for RHD advocacy and public health awareness to increase research on RHD.

Outcomes of rheumatic fever in Uganda: a prospective cohort study

“…First, incomplete data on secondary antibiotic prophylaxis adherence hampered our ability to detect any protective effect of high adherence against negative outcomes, as some studies suggest. 26 , 27 , 28 , 29 Data that were available showed that half of the patients had low adherence to secondary antibiotic prophylaxis, which is consistent with previous studies in sub-Saharan Africa that attribute suboptimal adherence to barriers that include fear of pain or anaphylaxis, limited health-care access, and low awareness of the detrimental consequences of acute rheumatic fever and rheumatic heart disease. 26 Second, our study included a relatively small sample size, which led to broad confidence intervals relating to our incidence rates and HRs and hampered our ability to detect risk factors that might have minor, but still important, effects on mortality.…”

Complete atrioventricular block in an adolescent with acute rheumatic fever: a case report

“…3 The incidence of acute rheumatic fever is estimated to be 8-51 per 100,000 people worldwide. 4 Sinus arrest, atrial tachycardia, junctional tachycardia, junctional rhythm, and AV conduction block are some of the rhythm disturbances associated with ARF.…”

Sore knee – why and when to call a cardiologist

“…ARF is a rare condition (1–3 per 100 000 people26) in the UK but is an important differential diagnosis for children presenting with joint pain and fever, given the long-term health implications of RHD. If concerned for rheumatic fever, discussion with the paediatric cardiology team is warranted.…”