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Acute rheumatic fever

Acute rheumatic fever (ARF) is a complication of a strep throat caused by particular strains of group A beta-haemolytic streptococci.

Clinical picture

Although common in developing countries, ARF is rare in the United States, with small isolated outbreaks reported only occasionally. It is most common among children between 5-15 years of age. A family history of ARF may predispose an individual to the disease.

Symptoms typically occur 18 days after an untreated strep throat. An acute attack lasts approximately 3 months. The most common clinical finding is a migratory arthritis involving multiple joints.

The most serious complication is carditis, or heart inflammation (rheumatic heart disease), as this may lead to chronic heart disease and disability or death years after an attack. Less common findings include bumps or nodules under the skin (usually over the spine or other bony areas) and a red expanding rash on the trunk and extremities that recurs over weeks to months. Because of the different ways ARF presents itself, the disease may be difficult to diagnose. A neurological disorder, chorea, can occur months after an initial attack, causing jerky involuntary movements, muscle weakness, slurred speech, and personality changes.


Initial episodes of ARF as well as recurrences can be prevented by treatment with appropriate antibiotics.

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