Diagnosis and Management of Acute Rheumatic Fever

Preventive Measures and Public Health Implications

Acute Rheumatic Fever (ARF) is an inflammatory disease triggered by Group A Streptococcus infection. It primarily affects the heart, joints, skin, and nervous system, leading to long-term complications such as Rheumatic Heart Disease (RHD). Understanding the diagnosis and management of ARF is crucial for reducing disease burden.

Etiology and Pathogenesis

ARF arises due to an autoimmune reaction following an untreated or inadequately treated streptococcal throat infection. The molecular mimicry between streptococcal antigens and human tissues leads to immune-mediated damage, especially in the heart valves.

Clinical Manifestations

• Carditis - valvular damage, pericarditis, and myocarditis
• Polyarthritis - migratory inflammation of large joints
• Syndenham's chorea - involuntary movements due to central nervous system involvement
• Erythema marginatum - characteristic skin rash
• Subcutaneous nodules - firm, painless nodules over bony prominences

Diagnosis

Diagnosis relies on the modified Jones Criteria, incorporating major and minor clinical findings alongside evidence of recent streptococcal infection.

Management

Management includes antibiotic therapy, anti-inflammatory treatment, and supportive care. Long-term penicillin prophylaxis prevents recurrence and progression to RHD.

Preventive Measures

• Early treatment of streptococcal infections with antibiotics
• Public health awareness programs
• Screening programs for at-risk populations
• Improvement of healthcare accessibility

Public Health Implications

ARF remains a major health challenge in low-resource settings. Implementing effective preventive measures and strengthening healthcare systems are crucial for controlling the disease burden.