Etiology, Pathogenesis, and Clinical Presentation of Acute Rheumatic Fever in Children

Introduction

Acute Rheumatic Fever (ARF) is an inflammatory disease that occurs as a sequela of untreated or inadequately treated Group A Streptococcal (GAS) pharyngitis. It primarily affects children and can lead to serious complications, including rheumatic heart disease.

Etiology

ARF is caused by an autoimmune response triggered by infection with Streptococcus pyogenes. The body's immune system mistakenly attacks its own tissues, leading to inflammation in the heart, joints, skin, and brain.

Pathogenesis

• Molecular Mimicry: Streptococcal antigens resemble human tissue proteins, leading to cross-reactivity.
• Inflammatory Response: Activation of immune cells results in tissue damage.
• Cardiac Involvement: Inflammation of heart valves (pancarditis) can lead to chronic rheumatic heart disease.

Clinical Presentation

Symptoms of ARF vary but commonly include:

• Fever
• Polyarthritis (migratory joint inflammation)
• Carditis (inflammation of the heart)
• Chorea (involuntary movements)
• Erythema marginatum (rash)
• Subcutaneous nodules

Prevention Strategies

Antibiotic Prophylaxis

Long-term antibiotic prophylaxis with penicillin is recommended to prevent recurrent episodes of ARF and progression to rheumatic heart disease.

Public Health Interventions

• Early diagnosis and treatment of streptococcal infections
• Improved hygiene and sanitation
• Access to healthcare and vaccination programs

Conclusion

Acute Rheumatic Fever remains a significant health concern, particularly in developing countries. Timely intervention through antibiotic prophylaxis and public health measures can reduce its incidence and prevent complications.