Acute rheumatic fever

Acute rheumatic fever (ARF) and its sequelae rheumatic heart disease (RHD) are systemic inflammatory conditions following group A beta haemolytic streptococcal (GABHS) pharyngitis. The condition primarily affects children between 5 years and 15 years of age mainly in developing countries and in indigenous populations of developed countries. Pathogenesis of the disease remains an enigma and specific treatment is not available; hence there is a lot of emphasis on prevention of initial and recurrent attacks. With protean manifestations, a high index of suspicion along with precise interpretation of clinical criteria (modified Jones criteria) is needed for the diagnosis. Clinical guidelines on the management of this condition with reference to the Indian scenario have been formulated. Antiinflammatory agents such as aspirin and steroids are the mainstay of symptomatic treatment of rheumatic fever. Primary prevention of ARF is accomplished by proper identification and adequate antibiotic treatment of GABHS tonsillopharyngitis. The most effective approach for control of ARF and RHD is secondary prophylaxis.