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Acute rheumatic fever (ARF) is an inflammatory condition following strep throat, potentially causing heart disease. ARF remains a significant health issue in developing nations, influenced by genetics and socioeconomic factors.
Area of Science:
- Rheumatology
- Pediatrics
- Infectious Diseases
Background:
- Acute rheumatic fever (ARF) is an inflammatory complication affecting 1-3% of children with group A streptococcal pharyngitis.
- Key manifestations include carditis, migratory polyarthritis, and chorea, with potential progression to rheumatic heart disease (RHD).
Purpose of the Study:
- To summarize the pathophysiology, clinical features, treatment, and epidemiological trends of ARF.
- To highlight the disparities in ARF incidence and mortality globally.
Main Methods:
- Literature review and synthesis of existing data on ARF and RHD.
- Analysis of epidemiological patterns and risk factors associated with ARF.
Main Results:
- ARF results from an abnormal immune response to streptococcal antigens, leading to cross-reactivity with host tissues.
- Treatment involves antibiotic eradication, anti-inflammatory medications, and supportive care.
- Incidence has declined in developed countries but remains high in developing nations, linked to genetic predisposition, inadequate healthcare, and socioeconomic conditions.
Conclusions:
- ARF and RHD represent a major global health challenge, particularly in resource-limited settings.
- Genetic factors, such as DR-HLA markers, play a role in susceptibility.
- Addressing socioeconomic determinants and improving healthcare access are crucial for ARF prevention and control.
Abstract:
Acute rheumatic fever (ARF) is an inflammatory sequela which occurs in 1-3% of children afflicted with group A beta-hemolytic streptococcal pharyngitis (strep throat). The major manifestations are carditis, migratory polyarthritis and chorea. ARF recurs with repeated strep throats and frequently leads to rheumatic heart disease (RHD), usually mitral and aortic regurgitation and mitral stenosis. ARF likely results from an abnormal host immune response with a host-antibody/streptococcal antigen production in pharyngeal tissue and subsequent cross-reaction of host antibodies with host end organs. Treatment includes eradication of the streptococcus, use of high doses of salicylates and adrenal corticosteroids, and prolonged bed rest with gradual ambulation after clinical and laboratory signs of the disease are gone. While the incidence and mortality of ARF and RHD have decreased drastically in the affluent industrialized countries of Europe, North America, and in Japan, the disease is a major health problem in the less affluent, 'developing' countries of Latin America, the Middle East, Africa, India and Southeast Asia. The major risk factors for ARF are believed to be genetic or familial, inadequate medical care and crowded conditions. The last two factors are socioeconomic but may also be influenced by ethnic cultural behavior. Genetic propensity for ARF is supported by recent evidence of a specific DR-HLA marker in the majority of people with ARF or RHD. Finally, while ARF appears to be vanishing in most areas of the country, it is still prevalent in some affluent populations and in some disadvantaged minorities.