Paediatrics - Queensland Health - Queensland Government

Immune complications
Acute rheumatic fever
Recommend
In Aboriginal and Torres Strait Islander communities where there are high rates of
acute rheumatic fever (ARF) and rheumatic heart disease (RHD) treat streptococcal
throat and skin infections early
Any case of arthritis with fever in a child should be considered as possible ARF
or septic arthritis and transferred to hospital for investigation and confirmation of
diagnosis
Regular penicillin prophylaxis is critical to prevent recurrences of ARF, which can
lead to the development or worsening of RHD
Background
ARF is an auto-immune response to bacterial infection with group A Streptococcus
(GAS) [1] in the throat (and possibly the skin); it affects the heart, joints, nervous
system and skin
Aboriginal and Torres Strait Islander Australians living in rural or remote settings are
known to be at high risk. Those living in urban settings, Maori and Pacific Islander
people and, potentially immigrants from developing countries also may be at high
risk [2]
ARF is predominantly a disease of children aged between 5 and 14 years although
recurrent episodes may continue well into the fourth decade of life [1]
Patients with recurring ARF have a higher risk of developing RHD
RHD is a chronic condition resulting from scarring and deformity of the heart valves
following ARF
Related topics
Upper respiratory tract infection - child
Upper respiratory tract infection - adult
Bacterial skin infections
Bone and joint infections - child
Acute rheumatic fever and rheumatic heart disease prophylaxis
1. May present with
• Fever and malaise
• Painful tender swollen joints. Symptoms classically seen to progress from one
joint to another (migratory polyarthritis) however only one joint may be affected
(aseptic monoarthritis). Any joint can be involved but most commonly affects the
large joints of the limbs - knees, ankles, elbows
• Abdominal pain
• Inability to weight-bear or walk unaided
• Uncontrollable jerky movements of the trunk, face and / or limbs (Sydenham’s
chorea), that disappear when asleep
• Skin rash. This is rare, but highly suggestive of ARF (can be difficult to see in
dark skinned people)
• Small nodules over bony areas such as elbows and knees; again rare
• History of a sore throat or skin infection within the previous 2 - 3 weeks
• Breathlessness (if cardiac involvement), chest pain
• Abnormal heart sounds
2. Immediate management Not applicable
Primary Clinical Care Manual 2011 Controlled copy V 1.0 575