[Acute rheumatic fever in children, a diagnostic problem]

Area of Science:

• Pediatrics
• Infectious Diseases
• Cardiology

Context:

• Rheumatic heart disease (RHD) prevalence is significantly higher in developing countries.
• Acute rheumatic fever (ARF) diagnosis in children requires careful consideration of symptoms and Jones criteria.
• Migrant children may present unique diagnostic challenges for ARF.

Purpose:

• To highlight the importance of considering ARF in children with unexplained fever, even if Jones criteria are not fully met.
• To underscore the potential for delayed diagnosis and severe cardiac sequelae in ARF.
• To emphasize the need for vigilance in diagnosing ARF in school-aged children, particularly those from at-risk populations.

Summary:

• Three girls of Moroccan descent diagnosed with ARF following Streptococcus infection were treated with penicillin and acetylsalicylic acid.
• One patient developed cardiac decompensation requiring valvuloplasty, while another was diagnosed with juvenile idiopathic arthritis after recurrent joint pain.
• The cases illustrate the varied presentations and potential long-term complications of ARF, including RHD.

Impact:

• Early and accurate diagnosis of ARF is crucial for preventing irreversible cardiac damage and reducing RHD prevalence.
• Increased awareness of ARF in primary care settings, especially for school-aged children and migrant populations, is warranted.
• This case series emphasizes the need for timely management of ARF to mitigate severe rheumatic heart disease outcomes.