Acute rheumatic fever and its consequences: a persistent threat to developing nations in the 21st century.
Acute rheumatic fever (ARF) is an autoimmune, multi-system response secondary to molecular mimicry following Lancefield group A streptococcus (GAS) pharyngitis; it is now most commonly found in the pediatric populations of developing nations. The major source of morbidity and mortality of ARF stems from rheumatic heart disease (RHD), although the cardinal symptoms of the disease also include polyarthritis, Sydenham's chorea, subcutaneous nodules, and erythema marginatum. Therapy is aimed towards treating the initial GAS infection, using anti-inflammatory medications for acute symptoms and surgery to correct RHD. Secondary prevention is crucial, given the high risk of recurrence, and includes long-term antibiotic prophylaxis. However, vaccination towards GAS may soon be on the horizon, which may assist in both decreasing the risk of initial infection in naïve patients and helping to lower the risk of recurrence.
Lee
Jennifer L
JL
Division of Rheumatology, Allergy and Clinical Immunology, University of California at Davis School of Medicine, Suite 6510, Davis, CA 95616, USA.
Naguwa
Stanley M
SM
Cheema
Gurtej S
GS
Gershwin
M Eric
ME
D019072:Antibiotic Prophylaxis / Q000639:trends; D001428:Bacterial Vaccines; D002388:Catastrophic Illness; D002648:Child; D003906:Developing Countries; D003937:Diagnosis, Differential; D049674:History, 21st Century; D006801:Humans; D009205:Myocarditis / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology / Q000276:immunology* / Q000503:physiopathology; D012214:Rheumatic Heart Disease / Q000150:complications / Q000175:diagnosis / Q000453:epidemiology / Q000276:immunology* / Q000503:physiopathology; D013297:Streptococcus pyogenes / Q000276:immunology* / Q000472:pathogenicity
D001428:Bacterial Vaccines