What is acute rheumatic fever?

Acute rheumatic fever (ARF) is an autoimmune response to an untreated infection of the throat and possibly skin by group A streptococcus (Strep A) bacteria (McDonald et al. 2004; May et al. 2016; Bennett et al. 2019; Lorenz et al. 2021; Thomas et al. 2021; Wyber et al. 2021). Not all people who have Strep A develop ARF but, in those affected, it usually develops within 2 to 3 weeks of the infection (Webb et al. 2015).

ARF can affect the heart, joints, brain, and subcutaneous tissues (the innermost layers of skin) (Parnaby & Carapetis 2010). While no lasting damage is caused to the brain, joints, or skin, ARF can cause lasting damage to the heart. There is no single diagnostic test for ARF. Australian guidelines recommend hospitalisation, so all necessary investigations are undertaken and to rule out other diagnoses.

The risk of ARF recurrence is relatively high after an initial episode. Repeated ARF increases the likelihood of long-term heart valve damage, known as rheumatic heart disease (RHD) (Carapetis et al. 2016). As each episode of ARF can worsen the damage to the heart, the goal of treatment is to prevent ARF recurrences using long-acting penicillin treatment, which is known as secondary prophylaxis. For people who are unable to use intramuscular penicillin, oral antibiotics may be offered.