Acute rheumatic fever in children: recognition and treatment.

Acute rheumatic fever (ARF) is an inflammatory disease of the heart, joints, CNS, and subcutaneous tissue that develops after a pharyngeal infection by one of the group A beta-hemolytic streptococci (Streptococcus pyogenes). The pathogenesis of the disease remains an enigma and specific treatment is not available, yet prevention of initial and recurrent attacks is possible by penicillin treatment. Rheumatic fever is especially important because of the heart disease that usually ensues; as succinctly stated by Lasegue many years ago, rheumatic fever "licks the joints and bites the heart", a statement that holds true today. Rheumatic fever is no longer a significant health problem in most socioeconomically advanced countries but it still causes 25-40% of all cardiovascular disease in the world, including tropical countries where it was once believed to be rare. In many countries it causes more hospital admissions than congenital heart conditions.ARF and rheumatic heart disease - with high associated morbidity, cost, and mortality - are largely preventable. Importantly, recurrences of rheumatic fever with their increased likelihood of more severe carditis are inexpensively preventable. Primary prevention has been achieved innovatively in some countries, for example, Costa Rica, and more conventionally in some developed countries. Treatment of the acute episode controls symptoms and may limit cardiac damage.