Acute rheumatic fever is an immunological response that most commonly affects children between 5-15 years of age from poorer socioeconomic backgrounds. It occurs as a result of an untreated streptococcal throat infection, where antibodies formed against the bacteria can cross-react with human heart tissues. Common symptoms include fever, migratory joint pains, and carditis which can lead to valve damage. Treatment involves antibiotics, activity restriction, and long-term preventative antibiotics to avoid recurrent bouts of the disease and worsening heart conditions.

1. Acute Rheumatic Fever
Dr. M. S. Prasad
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2. Acute Rheumatic Fever
• Occurs in 5 – 15 years of age-group.
• More common in children from poor socio-
economic background.
• Most likely an immunological response
resulting in damage to the heart by
antibodies.
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3. Aetiology
Untreated streptococcal sore-throat
Latent Period (10 d – several weeks)
Production of antibody during latent period
Antigen-Antibody Reaction
Rheumatic Fever
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5. Aetiology
Group-A beta haemolytic streptococcus
Infection of the throat
Antibody production against streptococcal antigen
Damage to Heart
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6. Etiology
• A history of preceding sore-throat.
• > 50% children with rheumatic fever do not
have a definite history of sore-throat.
• The antibodies formed against streptococcal
antigens have the capacity of react with
human connective tissue especially the
cardiac muscles.
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7. Aetiology
Antigen-Antibody Reaction
Connective Tissue
1. Arthritis
2. Fever etc.
Heart Muscles
1. Carditis
2. Damage to valves.
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8. Incidence
• ARF following URI = 0.5 – 3%.
• RHD: 25-50% of all cardiac admissions in India.
• Middle East, India, Pakistan, Bangladesh,
Nepal, Africa and South America.
• 20 million new cases every year.
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9. Sore-Throat
Appropriate Antibiotics
Worldwide decline of Rheumatic Fever
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10. Sex
• Female:
–Chorea,
–Tight Mitral Stenosis (MS).
• Male
–Aortic Regurgitation (AR).
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11. Clinical Features
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12. Most common:
Fever,
Migratory Joint Pains
Another subset:
Fever
Tachycardia
Tachypnea
Palpitation
Carditis:
CHF
New murmur
Pericarditis.
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16. Treatment
• Activity,
• Diet,
• Penicillin
• Suppressive Therapy
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17. Management of Chorea
• Self-limiting.
• Haloperidol,
• Complete physical and mental rest.
• Adequate sedation.
• Corticosteroid.
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18. Long Term Prevention
• Benzathine Penicillin,
• Penicillin-V
• Azithromycin.
• Erythromycin.
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