Acute rheumatic fever in children

Acute Rheumatic Fever (ARF), an autoimmune post-infectious complication of Group A Streptococcus (GAS) pharyngitis, remains among the most preventable causes of child heart disease in the world. It predominantly affects children aged 5–15 years in low- and middle-income countries (LMICs). ARF is a systemic inflammatory disease that involves the heart, joints, brain, and skin. If left untreated, it progresses to chronic rheumatic heart disease (RHD), which kills over 300,000 people annually. Though nearly eradicated in developed nations, ARF persists where poverty, overpopulation, and fragmented health systems prevail, mirroring profound global health inequities. This systematic review synthesizes current evidence regarding ARF epidemiology, pathogenesis, clinical management, and prevention. Core mechanisms such as molecular mimicry, whereby streptococcal antigens cross-react with human cardiac antigens, drive autoimmune tissue damage, particularly valvulitis. Diagnosis is made according to the revised Jones Criteria, though in endemic regions more and more echocardiography is used to diagnose subclinical carditis. Treatment is on the basis of early antibiotic therapy (e.g., benzathine penicillin G) to eradicate GAS, with anti-inflammatory medication (NSAIDs, corticosteroids) for symptom management. Secondary prophylaxis using long-acting penicillin remains necessary to prevent recurrence but resistance barriers occur in resource-poor environments.