Rheumatic Fever and Rheumatic Heart Disease in Children

Area of Science:

• Cardiovascular Medicine
• Rheumatology
• Public Health

Background:

• Acute rheumatic fever (ARF) and its sequela, rheumatic heart disease (RHD), are significant causes of cardiovascular morbidity and mortality, particularly in developing countries.
• RHD disproportionately affects individuals during their most productive years, highlighting its socioeconomic impact.
• Diagnostic criteria for ARF have evolved, with echocardiography now recognized as a major diagnostic criterion alongside clinical assessment.

Purpose of the Study:

• To review the current understanding of ARF and RHD diagnosis and management.
• To highlight the evolving diagnostic landscape, including the role of echocardiography.
• To emphasize the need for improved management strategies for established RHD to reduce mortality.

Main Methods:

• Review of updated diagnostic criteria for ARF, incorporating echocardiographic findings.
• Analysis of recent epidemiological data on RHD prevalence, particularly in school-aged populations.
• Discussion of current management strategies focusing on streptococcal pharyngitis treatment and ARF recurrence prevention.

Main Results:

• While ARF diagnosis was historically clinical, echocardiography is now a major criterion, enhancing diagnostic sensitivity.
• Despite a perceived decline in ARF, recent echocardiographic studies reveal a high prevalence of RHD among Indian school children.
• Current management focuses on streptococcal infection control and ARF prophylaxis, but established RHD management requires greater emphasis.

Conclusions:

• Effective management of ARF and RHD requires a multifaceted approach, including prompt diagnosis and treatment of streptococcal infections.
• Long-term antibiotic prophylaxis is essential for preventing ARF recurrences.
• Greater focus on the appropriate management of established RHD is critical to mitigate RHD-related mortality.