Streptococcus Research Articles

29 From throat to thorax: an unusual case of mediastinitis after streptococcal pharyngitis infection

29 From throat to thorax: an unusual case of mediastinitis after streptococcal pharyngitis infection

Incremento delle infezioni pediatriche da streptococco di gruppo A e complicanze trombotiche: studio restrospettivo e case series di trombosi dei seni venosi cerebrali

During the 2022 winter, Europe experienced a surge in invasive group A streptococcal (iGAS) infections in paediatric patients, accompanied by reports of severe complications such as cerebral venous sinus thrombosis (CVST). This study retrospectively analysed the cases of four patients with CVST secondary to otogenic infections due to Streptococcus pyogenes, who were admitted between November 2022 and March 2023 at the Bologna Ospedale Maggiore. All patients presented with sepsis signs and otogenic symptoms, with imaging confirming CVST. Treatment included broad-spectrum antibiotics, anticoagulation and surgical interventions, which led to full recovery. The findings highlight the need for early recognition, timely imaging and appropriate management in severe iGAS cases.

Using machine learning to forecast peak health care service demand in real-time during the 2022-23 winter season: A pilot in England, UK.

During winter months, there is increased pressure on health care systems in temperature climates due to seasonal increases in respiratory illnesses. Providing real-time short-term forecasts of the demand for health care services helps managers plan their services. During the Winter of 2022-23 we piloted a new forecasting pipeline, using existing surveillance indicators which are sensitive to increases in respiratory syncytial virus (RSV). Indicators including telehealth cough calls and emergency department (ED) bronchiolitis attendances, both in children under 5 years. We utilised machine learning techniques to train and select models that would best forecast the timing and intensity of peaks up to 28 days ahead. Forecast uncertainty was modelled usings a novel generalised additive model for location, scale and shape (gamlss) approach which enabled prediction intervals to vary according to the level of the forecast activity. The winter of 2022-23 was atypical because the demand for healthcare services in children was exceptionally high, due to RSV circulating in the community and increased concerns around invasive group A streptococcal (iGAS) infections. However, our short-term forecasts proved to be adaptive forecasting a new higher peak once the increasing demand due to iGAS started. Thus, we have demonstrated the utility of our approach, adding forecasts to existing surveillance systems.

Revolutionizing rheumatic heart disease prevention: the potential of high-dose subcutaneous benzathine penicillin G: a narrative review

Rheumatic heart disease (RHD) is a severe, chronic condition arising from acute rheumatic fever (ARF), a complication of untreated group A - Streptococcus infections. RHD results in progressive damage to the heart valves, leading to significant morbidity and mortality. While RHD has declined in high-income countries due to effective prophylaxis, it remains a major health issue in developing regions. Approximately 15 million people worldwide are affected by RHD, impacting quality of life and healthcare systems. This narrative review evaluates the efficacy and safety of high-dose subcutaneous benzathine penicillin G (BPG) injections as a preventive strategy for RHD. Traditionally administered intramuscularly, the review explores the subcutaneous route’s benefits. Subcutaneous BPG is effective in preventing ARF recurrences and managing RHD progression. It maintains therapeutic penicillin levels over extended periods, potentially reducing injection frequency. This method is associated with less pain and improved patient adherence compared to intramuscular injections. However, subcutaneous BPG administration has challenges. Adverse effects, such as allergic reactions and anaphylaxis, though infrequent, require careful management. Consistent drug supply is also essential. Future research should explore innovative delivery methods, such as implantable devices or transdermal systems, to further improve patient outcomes. In conclusion, high-dose subcutaneous BPG injections offer a promising option for RHD prophylaxis, combining efficacy with a favorable safety profile. Addressing administration and side effect challenges is crucial for optimizing treatment effectiveness.

SLO co-opts host cell glycosphingolipids to access cholesterol-rich lipid rafts for enhanced pore formation and cytotoxicity.

Group A Streptococcus is a global public health concern as it causes streptococcal sore throat and less common but potentially life-threatening invasive infections. Invasive infections have been associated with bacterial strains that produce large amounts of a secreted toxin, streptolysin O (SLO), which belongs to a family of pore-forming toxins produced by a variety of bacterial species. This study reveals that SLO binds to a class of molecules known as glycosphingolipids on the surface of human cells and that this interaction promotes efficient binding of SLO to cholesterol in the cell membrane and enhances pore formation. Understanding how SLO damages human cells provides new insight into streptococcal infection and may inform new approaches to treatment and prevention.

Septicemic omphalophlebitis by Streptococcus equi subsp. zooepidemicus in a southern right whale calf (Eubalaena australis).

Southern right whales (Eubalaena australis) are mysticete cetaceans commonly observed in the coastal waters of Brazil, particularly in Santa Catarina State. There is limited understanding of the causes of calf mortality in this species, particularly concerning infectious diseases. We report a case of omphalophlebitis caused by Streptococcus equi subsp. zooepidemicus (S. zooepidemicus) that led to septicemia in a Southern right whale calf. Gross examination revealed an incompletely healed umbilicus with fibrin deposition and amorphous yellow material present in the lumen of the umbilical vein on the cut surface. The main histopathological findings showed fibrinosuppurative omphalophlebitis with numerous coccoid basophilic bacterial aggregates. These aggregates were also observed in the lamina propria, submucosa, and muscular layers of the small intestine and uterus, as well as in the interstitium of the kidneys and within blood vessels of the skin, skeletal muscle, heart, and ovaries. Tissue samples taken from the umbilicus and uterus were inoculated on 5% sheep blood agar and MacConkey agar. Small, transparent colonies that exhibited complete hemolysis were identified on blood agar. Gram staining revealed the presence of Gram-positive cocci arranged in chains. The bacterial isolate was analyzed using the MALDI-TOF technique, which confirmed its identity as S. zooepidemicus. The presence of S. equi antigen in the extra-umbilical aggregates was confirmed through immunohistochemistry. These findings underscore the significance of streptococcal infections in cetaceans and contribute valuable data regarding calf mortality in baleen whales. Furthermore, we provide new insights into the understanding of marine ecosystem health markers.

Common Isolates and Antibiotic Susceptibility Pattern of Urine Samples among Patients Attending a Tertiary Health Institution in South Nigeria

Aim: To identify the main isolates in Urinary Tract Infection (UTI) and their antibiotic susceptibility patterns in Federal Medical Centre Asaba as a guide to developing corresponding antibiogram to support empirical treatment of these infections. Study Design: A three - year retrospective cross-sectional study. Place and Duration of Study: Federal Medical Centre, Asaba, Delta State, Nigeria between 1st of January 2019 to 31st December 2022. Methodology: A three - year retrospective cross-sectional study carried out by reviewing laboratory records with a focus on identifying bacterial pathogens causing UTI as well as evaluating their antibiotics susceptibility in Federal Medical Centre, Asaba, Delta State, Nigeria. All Urine microscopy, culture and sensitivity results from the 1st of January 2019 to 31st December, 2022 were collected and reviewed. Results: A total number of 2113 results of subjects, 683 males and 1430 females, that attended the tertiary hospital from the 1st of January 2019 to 31st December 2022 were reviewed. The bacterial strains identified/isolated among the population studied were Staphylococcus aureus 907 (42.9%), Escherichia coli 866 (41.9%), Klebsiella spp 232 (11.0%), Pseudomonas aeruginosa 54 (2.6%), Proteus spp 31 (1.4%), Streptococcus spp 2 (0.1%) and Pantoea spp 1.The records revealed that the organisms were isolated more in female subjects (66.7%) than male subjects (33.3%), Staphylococcus aureus 285 males, 622 females, Escherichia coli 294 males, 592 females, Klebsiella spp 62 males, 170 females, Pseudomonas aeruginosa 29 males 25 females, Proteus spp 13 males, 18 females, Streptococcus spp 2 females. Pantoea spp 1 female as well. The highest percentages of resistance have been observed against tested antibiotics. Conclusion: Most of the isolates were extended spectrum β-lactamase producers and multidrug-resistant. We observed that Gram-negative bacteria were the main cause of UTIs where the predominant microorganism was E. coli.

Streptococcal Toxic Shock Syndrome Due to Invasive Group A Streptococcal M1UK Strain Infection in a Previously Healthy Child

Streptococcal Toxic Shock Syndrome Due to Invasive Group A Streptococcal M1UK Strain Infection in a Previously Healthy Child

Mutual influence of clinical manifestations of intestinal disorders and intestinal microbiot indicators in patients with deep endometriosis

Summary. Endometriosis is a chronic multifactorial disease that affects more than 170 million women of reproductive age worldwide, causing pelvic pain syndrome, dyspareunia, and symptoms of gastrointestinal dyspepsia, thereby having a negative impact on the psycho-emotional state of patients. Despite a wide range of medical and surgical treatments, the relapse rate reaches 50%, which is a global economic and social problem.The purpose of the study. to evaluate the mutual influence of clinical manifestations of intestinal disorders and the state of the intestinal microbiota in patients with deep endometriosis.Materials and methods. The study included 83 patients of reproductive age who underwent surgical treatment of common forms of external genital endometriosis. The first group consisted of 32 patients of reproductive age who underwent repeated surgical treatment due to relapse of deep infiltrative endometriosis, the second group — 51 patients without relapse of the disease one year after the primary operation, due to deep infiltrative endometriosis, the third group — 30 patients of reproductive age. not suffering from external genital endometriosis. An analysis of the somatic anamnesis was carried out, as well as questionnaire data on pelvic pain on a visual analogue scale (VAS) and functional bowel disorders in patients with deep infiltrating endometriosis, depending on the status of relapse of the disease. The composition of the intestinal microbiota was assessed by quantitative real-time PCR using a test system for determining the DNA of intestinal-associated microorganisms.Results and discussion. The results of the study demonstrate bidirectional relationships between clinical and microbiological parameters and the recurrent course of deep endometriosis. Patients of the main group significantly more often suffered from functional diseases of the gastrointestinal tract, the spectrum of which was represented by chronic gastritis and irritable bowel syndrome. Correlation relationships between indicators of the Bacillota domain of the intestinal microbiota and clinical and anamnestic indicators of gastrointestinal pathology, the values of questionnaire scales in patients with deep endometriosis demonstrate moderate positive relationships between the weight of patients and the number of Lachnospiraceae (r = 0.63299), symptoms of bloating and the number Streptococcus spp (r=0.67402). Correlation relationships between indicators of the Bacteroidota domain of the intestinal microbiota and corresponding indicators demonstrate strong positive relationships between the amount of E.Coli in the intestinal microbiota and the level of pain assessed on the VAS scale after 1 (r = 0.62366) and 3 months (r = 0. 72598) after surgery. Moderate positive correlations were revealed between the number of Enterobacterales in the intestinal microbiota and the level of pain assessed on the VAS scale 1 (r=0.58169) and 3 months (r=0.57706) after surgery.Conclusions. The recurrent course of endometriosis is accompanied by functional intestinal disorders, the manifestations of which persist after surgical treatment, which is mediated by changes in the intestinal microbiota. In patients with recurrent deep endometriosis, a decrease in the species and taxonomic diversity of the intestinal microbiota was found, due to an increase in the Bacillota/Bacteroidota ratio, the number of pathobionts, and a decrease in the number of commensal bacteria of the genus Bifidobacterium spp. These clinical and microbiological parallels demonstrate the need to harmonize the intestinal microbiota as a comprehensive prevention of disease relapse.

Increased Incidence and Severity of Group A Streptococcal Infections in Children in Southeast Texas From June 2022 to May 2023

Increased Incidence and Severity of Group A Streptococcal Infections in Children in Southeast Texas From June 2022 to May 2023

Invasive group B streptococcal infections in Western Australia, 2000-2018.

Neonatal and puerperal sepsis are major manifestations of invasive group B streptococcal (Streptococcus agalactiae; iGBS) infections. International data indicate the importance of iGBS infections among non-pregnant adults. To describe the burden of iGBS infections in Western Australia (WA) between 2000 and 2018 in terms of incidence, length of hospitalisation and all-cause 30- and 90-day mortality. This was a retrospective, population-based study using linked data from the state government-owned pathology provider, hospitalisations and death registrations. Children and adults with isolation of GBS in a normally sterile site or a hospital-based diagnosis of iGBS infection were included. There were 2861 cases; just over a quarter (n = 768) were aged 0-1 year. Half of the cases were among females (1438 of 2861), and the median age was 39 years. Incidence increased over the study period, with an age- and sex-adjusted incidence rate ratio for year of 1.08 (95% confidence interval (CI) 1.06-1.09). The incidence in 2018 was 9.5 cases (95% CI 8.3-10.6 cases) per 100 000 population. The proportion of cases among those aged 0-1 year fell across the period, while the relative incidence in older age groups increased. The median length of hospital stay was 7 days (interquartile range 4-15 days), and mortality at 30 days was 3% (95 of 2861). iGBS cases increased across the period 2000-2018 in WA, with older adults making up a higher proportion of cases over time. Preventive efforts among older patients, including potentially through vaccination, may reverse this increase.

Glucose Supplementation Enhances the Bactericidal Effect of Penicillin and Gentamicin on Streptococcus sanguinis Persisters.

Background: Streptococcus sanguinis is a leading cause of infective endocarditis (IE), which causes diverse clinical symptoms and even death. Recurrence after treatment is a crucial problem in IE, possibly caused by the presence of "persister" cells, a small bacterial population that can survive antimicrobials. In this study, the residual risk for penicillin G (PCG) and gentamicin (GM), used for treating IE, to induce Streptococcus sanguinis persisters, was investigated. Methods: The bactericidal effects of PCG and GM on S. sanguinis were evaluated. Furthermore, we confirmed whether the S. sanguinis that survived following combination treatment with PCG and GM were persisters. The bactericidal effect of the combination of PCG and GM against S. sanguinis was measured after the addition of glucose or arginine. Results: Following 48 h of treatment with PCG (1600 μg/mL) and GM (64 μg/mL), S. sanguinis survived, albeit with a low bacterial count, indicating the presence of persisters. The addition of glucose or arginine to PCG and GM increased the bactericidal effect on residual persister cells and reduced the number of persister cells. Moreover, the addition of glucose at concentrations of 10 mg/mL or higher was substantially effective in achieving sterilization. Conclusions: Our findings demonstrate that persisters of S. sanguinis that survive antimicrobial treatment may make the treatment of IE challenging, and that combining antimicrobial treatment with glucose is effective for eliminating persisters of S. sanguinis. Taken together, these findings may facilitate the development of novel therapeutic strategies against IE caused by oral streptococcal infection.

Fifteen-Year Retrospective Study: Prevalence of Bacterial Isolates in Mastitis-Suspected Milk Samples Submitted to Central Veterinary Laboratory, Nepal

Bovine mastitis, a prevalent mammary gland inflammation, significantly impacts dairy production worldwide. This study investigated the changing landscape of mastitis-causing bacteria in Nepal. A retrospective analysis of secondary data was conducted, utilizing technical bulletins published by the Central Veterinary Laboratory (CVL) in Kathmandu over a fifteen-year period (2003/2004 to 2017/2018). The analysis focused on 3,445 bovine milk samples screened for mastitis using the California Mastitis Test (CMT).The analysis revealed Staphylococcus spp. as the most prevalent bacterial isolate (2,948 positive samples), followed by E. coli and Streptococcus spp. This finding suggests a potential shift in the dominant mastitis pathogens in Nepal, with Staphylococcus spp. potentially surpassing E. coli compared to previous reports. These results highlight the importance of implementing hygiene practices during milking to reduce the spread of contagious pathogens like Staphylococcus spp. Additionally, maintaining clean milking environments can help minimize E. coli infections. Further research is warranted to understand the factors driving this potential shift in bacterial prevalence and develop targeted prevention and control strategies for mastitis in Nepal.

Anaemia in a child with chronical disease and a newly diagnosed hypoparathyreosis

Anemia of chronic patients is a secondary hematological syndrome, and most often accompanies infectious-inflammatory, immunopathological and tumor processes. The introduction discusses the importance of blood testing to assess the response of the immune and hematopoietic systems to various adverse effects. Various mechanisms are involved in the pathogenesis of anemia, among which the main place belongs to the action of proinflammatory cytokines. In many cases, sideropenia develops that is not associated with an absolute iron deficiency, but occurs as a result of the redistribution of iron reserves in the body. In some patients, diagnosis of various types of pathology begins with the detection of anemia. This requires a comprehensive examination of patients, the exclusion of primary hematological pathology and the detection of all concomitant diseases, including foci of infection. This article presents a clinical example of a multidisciplinary approach to the diagnosis of normochromic normocytic anemia, which resulted in the detection of endocrine pathology — hypoparathyroidism, and chronic foci of Epstein–Barr virus and streptococcal infection in a teenage girl. The peculiarity of the case was that the patient initially consulted a hematologist about mild anemia, but during the examination it became obvious that complaints of progressive weakness, fatigue, hand tremors, and dizziness could not be linked to the existing hematological pathology. Spastic disorders and tetany of the limb muscles that arose during the examination period became the reason for diagnosing metabolic disorders: determining creatine phosphokinase, serum myoglobin, blood electrolytes, including calcium and phosphorus, as well as hormones of the thyroid and parathyroid glands. The examination results showed that the severity of the girl’s condition and neurological symptoms were caused by severe metabolic changes, phosphorus-calcium metabolism disorders in the form of hypocalcemia, hyperphosphatemia, increasing levels of creatine phosphokinase, high levels of lactate dehydrogenase, and were due to endocrine pathology. The presence of neurological symptoms, changes in magnetic resonance imaging and electrocardiogram against the background of a significant decrease in parathyroid hormone, hypocalcemia, and increasing levels of creatine phosphokinase required the patient to be referred to the hospital with a diagnosis of “Hypoparathyroidism”. The presented clinical case confirms the need for an individual, multidisciplinary approach to the diagnosis of secondary anemic conditions, which will allow identifying pathology of various organs and systems.

Characterization of an Acetogenin-Carrying Nanosuspension and Its Effect on Bacteria of Interest in the Poultry Industry.

This work aimed to develop a nanosuspension (NSps) as an acetogenin (ACGs) carrier, using soy lecithin (SL) and hydroxypropyl-β-cyclodextrin (βCD) named NSps-βCDSL-ACGs. It was characterized by various spectroscopic techniques (DLS, FTIR, UV-vis diffuse reflectance). Moreover, the NSps morphology was observed by transmission electron microscopy (TEM). Also, the antibacterial activity of NSps-βCDSL-ACGs was evaluated against strains of interest in the poultry sector. NSps-βCDSL-ACGs presented nanometric size (207-239 nm), acceptable polydispersity index (PDI) values (0.13-0.17) and a high Z potential value (-47.17-50.36 mV), demonstrating high stability. The presence of ACGs in NSps-βCDSL-ACGs was confirmed by FTIR analysis. The nanoparticles had a spherical shape and exhibited high inhibition potential against Salmonella Enteritidis (88.18%), Streptococcus gallolyticus (88.01%), Salmonella Typhimurium (86.28%) and Salmonella Infantis (77.02%) strains up to 48 h, and a reduction of up to 3 log CFU/mL was achieved for S. Typhimurium. Therefore, NSps-βCDSL-ACGs is an attractive option for implementing ACGs administration in the poultry sector to reduce the use of antibiotics and minimize bacterial resistance.

Group A streptococcal infections in Alberta, Canada 2018-2023.

Group A streptococcal infections in Alberta, Canada 2018-2023.

Comparing the safety of a single balloon catheter to dinoprostone for inducing labor in pregnant women with group B Streptococcus vaginal colonization: An observational study.

Group B Streptococcus is a bacterium that colonizes in approximately 20% of pregnant women and can be vertically transmitted to newborns, leading to maternal-neonatal adverse outcomes, such as chorioamnionitis, neonatal sepsis, and pneumonia. However, there is currently no agreement on the optimal induction method for this specific population. This study aims to evaluate the safety of a single balloon catheter (BC) in comparison to dinoprostone for labor induction in term pregnant women with group B Streptococcus colonization. In this retrospective cohort study, a total of 321 term pregnancies with positive group B Streptococcus requiring Induction of labor (IOL) were included. Out of these, 80 pregnancies were induced with a single BC, while the remaining 241 were induced with dinoprostone. The study compared the safety outcomes between the 2 groups, specifically focusing on maternal and neonatal adverse events. It is important to note that all women in the study received prophylactic antibiotics. When prophylactic antibiotics were administered, no significant differences were observed in terms of mode of delivery, clinical chorioamnionitis, puerperal infection, fetal distress, neonatal asphyxia, neonatal infection, neonatal sepsis, NICU admission, and neonatal pneumonia between the 2 induction methods (all P > .05). Additionally, there were no reported cases of neonatal group B Streptococcus infection following balloon induction in pregnant women with vaginal GBS colonization. In relation to maternal and neonatal adverse events, the study findings indicated that labor induction using a BC was deemed safe for women who were colonized with group B Streptococcus, provided that prophylactic antibiotics were administered either at the onset of labor or when the membranes ruptured.

Differences in microorganism profile in periprosthetic joint infections of the hip in patients affected by chronic kidney disease

BackgroundPatients affected by chronic kidney disease (CKD) are at increased risk of periprosthetic joint infection (PJI) after total hip arthroplasty (THA). This patient population has a higher risk of recurrent infections and hospitalization. The aim of this study is to compare the profile of microorganisms in patients with CKD and PJI of the hip versus controls and to individuate potentially unusual and drug-resistant microorganisms among the causative bacteria.Materials and methodsA total of 4261 patients affected by PJI of the hip were retrospectively studied. Patients affected by CKD in this population were identified and compared with a control group of patients with PJI but without CKD. Data on patient characteristics and comorbidities were collected. The microorganisms responsible for PJI were identified and compared between both groups.ResultsThe CKD group included 409 patients, 54.3% male, mean age of 73.8 ± 8.9 years, a higher body mass index (BMI) than the general population (29.88 ± 5.90 kg/m2), and higher age-adjusted CCI of 6.15 ± 2.35. Overall, 70 different isolates of microorganisms were identified, including 52 Gram-positive spp., 28 Gram-negative spp., 3 fungi, and 1 mycobacterium. Polymicrobial infections were more common in CKD group than controls (47.9% versus 30.9%; p < 0.0001). Staphylococcus spp. were the most common bacteria in both groups, followed by Gram-negative Enterobacteriaceae and Streptococcus spp. CKD group showed a higher risk of developing infections caused by Staphylococcus aureus (p = 0.003), Gram-negative bacteria, and Candida (p = 0.035).ConclusionsRenal failure exposes patients who undergo THA to PJI caused by microorganisms that are potentially more drug resistant, leading to a higher risk of treatment failure. Knowing in advance the different microorganism profiles could help to plan a different surgical strategy.Level of Evidence III.

Behavioral problems in children with unoperated rheumatic heart disease at national referral hospital in Ethiopia: an observational study

BackgroundThe behavioral disorder is characterized by a profound abnormality in an individual’s cognition, emotion or behavior that reflects in psychological, biological or developmental dysfunction. Rheumatic heart disease (RHD) is a long-term sequel of single or recurrent acute rheumatic fever. Children with RHD are thought to be at increased risk for behavioral problems due to autoimmunity seen in pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections (PANDAS). Behavior disorder is not well studied among children with RHD. Hence, this study aimed to assess the pattern and predictors of behavioral problems among children with RHD enrolled in chronic care at a national cardiac referral Hospital.MethodsThis cross-sectional study used a validated parental-reported Amharic Strengths and Difficulties Questionnaire (SDQ) to assess behavior problems. Children with RHD aged 6–17 years on chronic outpatient cardiac care at Tikur Anbessa Specialized Hospital, Ethiopia between February and May 2023 were included. Factors associated with behavior problems were assessed using logistic regression models.ResultsThe study included 166 children with a median age of 15 years [Interquartile range (IQR):13–17 years]. One-fourth of children, 24.7% (95% CI: 18.34–31.98), had behavioral problems. Of these, 46.4% (77) emotional, 35.5% (59) peer, 18.1% (30) conduct and 6.6% (11) hyperactivity problems were documented. Children who had good medication adherence, adjusted odds ratio AOR 0.29(95% CI: 0.09–0.94, P 0.040) and on New York Health Association (NYHA) class I, AOR 0.28(95% CI: 0.11–0.79, P 0.016) had lower odds for behavioral problems.ConclusionOne-fourth of children with RHD had behavioral abnormalities. Medication adherence and NYHA predicted behavioral abnormality. Better physical symptom control was associated with fewer behavioral problems. Behavioral abnormalities should be considered and assessed among children with RHD. Further multi-center mixed studies are recommended to uncover the unseen behavioral problem and guide health policy action on modalities of integration of behavioral problems assessment tools in clinical care.

Acute rheumatic fever in young adult patients: a case report

Acute rheumatic fever (ARF) is an inflammatory response to group A Streptococcus (GAS) infection. The incidence ranges from 8 to 51 per 100.000 children and young adults worldwide. A 19-year-old male patient admitted with complaint of abdominal pain and joint pain of knee in both legs and elbow in both hands. Multiple erythematous macules, round in shape, elevated of white blood cells and anti-streptolysin O titer (ASOT) are present in this case. The diagnosis of ARF is made using the Jones criteria. Intramuscular benzathine penicillin G as a single dose is recommended for management of ARF and as secondary prophylaxis to prevent recurrences. Comprehensive treatment was needed for patient with rheumatic fever to prevent reoccurrence and also complication which may arise.