Acute rheumatic fever

Abstract

<h2>Abstract</h2> Aetiology: acute rheumatic fever (ARF) is a systemic inflammatory disease that occurs 2–3 weeks after a group A streptococcal infection. ARF is mediated by an autoimmune response to antigenic components of the organism that cross-react with similar epitopes in the heart, joints, brain and skin. Presentation: ARF is characterized by major and minor manifestations. Major manifestations are arthritis (migratory polyarthritis), cardiac abnormalities (pericarditis, myocarditis, and valvulitis), neurological changes (Sydenham's chorea), and cutaneous involvement (erythema marginatum, subcutaneous nodules). Minor manifestations of ARF are fever, arthralgia, a prolonged PR interval, and elevated acute phase reactants (ESR, C-reactive protein). Diagnosis: the diagnosis of the initial episode of ARF requires the presence of two major manifestations or one major and two minor manifestations, plus evidence of preceding group A streptococcal infection (e.g. elevated or rising streptococcal antibody titre). A recurrence may be diagnosed on the basis of a single major or several minor manifestations in a patient with a history of ARF or established rheumatic heart disease. Management: the aims of treatment of ARF are to suppress the inflammatory response so as to minimize cardiac damage, to provide symptomatic relief and eradicate streptococcal infection. All patients with ARF require long-term secondary antibiotic prophylaxis to prevent recurrent attacks. Prognosis: carditis is the most serious manifestation of ARF as it may lead to severe life-threatening heart failure. If antibiotic prophylaxis is not used, repeated attacks of ARF lead to chronic rheumatic heart valve disease, heart failure, and a shortened life span.