Management of Acute Rheumatic Fever in Children

Cardiac Complications and Long-Term Management of Rheumatic Heart Disease

Acute Rheumatic Fever (ARF) is an inflammatory disease caused by untreated Streptococcus pyogenes infections. It primarily affects the heart, joints, skin, and nervous system.

Causes and Pathogenesis

ARF results from an autoimmune reaction following a streptococcal throat infection. The body's immune response mistakenly targets cardiac tissues, leading to valvular damage.

Symptoms of Acute Rheumatic Fever

• Fever
• Polyarthritis (swelling and pain in joints)
• Carditis (inflammation of the heart)
• Chorea (involuntary movements)
• Erythema marginatum (skin rash)

Diagnosis

ARF is diagnosed using the modified Jones criteria, including major and minor clinical manifestations. Laboratory tests and echocardiography help confirm the diagnosis.

Cardiac Complications

Carditis is the most serious manifestation, potentially causing Rheumatic Heart Disease (RHD). RHD leads to chronic valvular dysfunction, requiring lifelong monitoring.

Management Strategies

• Antibiotic therapy (penicillin to eradicate streptococcal infection)
• Anti-inflammatory treatment (aspirin or corticosteroids)
• Long-term prophylaxis with benzathine penicillin
• Regular cardiac evaluations
• Surgical intervention for severe valvular disease

Preventive Measures

Primary prevention focuses on early treatment of streptococcal throat infections. Secondary prevention includes long-term antibiotic prophylaxis to prevent recurrence.