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 mistakenly attack heart muscles and valves. Common symptoms include fever, migratory joint pains, and potential heart complications such as congestive heart failure or new heart murmurs. Treatment focuses on activity limitations, a heart-healthy diet, antibiotics to prevent future throat infections, and potentially long-term preventative antibiotics or corticosteroids to manage symptoms like chorea.

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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