Definition
Acute rheumatic fever (ARF) is a non-suppurative, immune-mediated inflammatory disease that follows group A streptococcal pharyngitis after a latent period of about 2–4 weeks. It affects the heart, joints, brain, skin and subcutaneous tissue.
- Rheumatic carditis (rheumocarditis) is the cardiac involvement of ARF: a pancarditis (endocardium, myocardium and pericardium). It is the only manifestation that can leave permanent damage.
- Rheumatic heart disease (RHD): the chronic valve damage left by one or, more often, repeated attacks.
- "It licks the joints but bites the heart": arthritis heals completely, carditis scars the valves.
Epidemiology
- Mainly children aged 5–15 years; first attacks are rare before age 3 and uncommon in adults. Recurrences can occur in adults.
- RHD affects about 40 million people worldwide and causes roughly 300,000 deaths a year, almost all in low- and middle-income countries (sub-Saharan Africa, South Asia, the Pacific, Indigenous Australians). It is the leading cause of acquired heart disease in young people there.
- Rare in Europe and North America (better housing, less crowding, penicillin for sore throat), but it is still the classic cause of mitral stenosis seen in adults, often immigrants.