LECTION
Pediatrics
doi: 10.25005/2074-0581-2025-27-2-399-405
ACUTE RHEUMATIC FEVER IN CHILDREN

S.S. UMAROVA, L.A. MUKHAMADIEVA

Department of Pediatrics № 3 and Medical Genetics, Samarkand State Medical University, Samarkand, Republic of Uzbekistan

The issue of reducing the incidence of acute rheumatic fever (ARF) has mainly been addressed, particularly in developed countries, due to a better understanding of the disease's etiology and the introduction of penicillin. However, recent outbreaks in various countries have reignited interest in this problem. In response to statistical data, the World Health Organization has adopted a resolution to enhance global and national efforts to prevent and combat ARF and rheumatic heart disease.

ARF is a systemic inflammatory disease that often results from pharyngitis caused by group A streptococci. It remains one of the leading causes of heart disease in developing nations. A significant factor in the disease's development is the interplay between the source of infection, the type of microbe, and the individual's susceptibility to it. Key clinical manifestations include carditis, migratory polyarthritis, chorea, erythema marginatum, and subcutaneous nodules. Diagnosis of rheumatic fever relies on the Jones criteria, which were first developed in 1944 and later revised twice by the American Heart Association (AHA) in 1992 and 2015.

This article examines aspects of ARF diagnostics, specifically evaluating the updated Jones criteria proposed by the AHA in May 2015. Emphasis is placed on disease prevention, particularly secondary prevention, which aims to prevent recurrent episodes. An analysis of materials published from 2014 to 2024 is included, highlighting significant advancements in scientific research. This analysis utilized reputable resources, including PubMed and ResearchGate, which are extensive knowledge bases in the fields of medicine and science.

Keywords: Rheumatic fever, Jones criteria, diagnostics, prevention, children.

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References
  1. Mirabel M, Narayanan K, Jouven X, Marijon E. Cardiology patient page. Prevention of acute rheumatic fever and rheumatic heart disease. Circulation. 2014;130(5):e35-7. https://doi.org/10.1161/CIRCULATIONAHA.113.007855
  2. He VY, Condon JR, Ralph AP, Zhao Y, Roberts K, de Dassel JL, et al. Long-term outcomes from acute rheumatic fever and rheumatic heart disease: A data- linkage and survival analysis approach. Circulation. 2016;134(3):222-32. https:// doi.org/10.1161/CIRCULATIONAHA.115.020966
  3. Dixit J, Brar S, Prinja S. Burden of group A streptococcal pharyngitis, rheumatic fever, and rheumatic heart disease in India: A systematic review and meta- analysis. Indian Journal of Pediatrics. 2022;89(7):642-50. https://doi. org/10.1007/s12098-021-03845-y
  4. Feng Z, Yang X, Zhang B, Mo C, Li C, Tian X, et al. Exploring the relationship between infectious agents and autoimmune diseases: A review. European Jour- nal of Clinical Microbiology & Infectious Diseases. 2024;43(8):1505-16. https:// doi.org/10.1007/s10096-024-04869-w
  5. Sadiq NM, Afshan G, Qureshi AU, Sadiq M. Current clinical profile of acute rheumatic fever and recurrent acute rheumatic fever in Pakistan. Pediatric Cardi- ology. 2024;45(2):240-7. https://doi.org/10.1007/s00246-023-03378-5
  6. Ou Z, Yu D, Liang Y, Wu J, He H, Li Y, et al. Global burden of rheumatic heart disease: Trends from 1990 to 2019. Arthritis Research and Therapy. 2022;24(1):138. https://doi.org/10.1186/s13075-022-02829-3
  7. Omurzakova NA, Yamano Y, Saatova GM, Mirzakhanova MI, Shukurova SM, Kydyralieva RB, et al. High incidence of rheumatic fever and rheumatic heart disease in the republics of Central Asia. Int J Rheum Dis. 2009;12(2):79-83. https://doi.org/10.1111/j.1756-185X.2009.01388.x
  8. Negi PC, Sondhi S, Asotra S, Mahajan K, Mehta A, Current status of rheumatic heart disease in India. Indian Heart J. 2019;71(1):85-90. https://doi. org/10.1016/j.ihj.2018.12.007
  9. Munteanu V, Petaccia A, Contecaru N, Amodio E, Agostoni CV. Pediatric acute rheumatic fever in developed countries: Neglected or negligible disease? Results from an observational study in Lombardy (Italy). AIMS Public Health. 2018;5(2):135-43. https://doi.org/10.3934/publichealth.2018.2.135
  10. Bennett J, Rentta NN, Leung W, Atkinson J, Wilson N, Webb R, et al. Early diagnosis of acute rheumatic fever and rheumatic heart disease as part of a secondary prevention strategy: Narrative review. J Paediatr Child Health. 2021;57(9):1385- 90. https://doi.org/10.1111/jpc.15664
  11. Oliver JR, Pierse N, Stefanogiannis N, Jackson C, Baker MG. Acute rheumatic fever and exposure to poor housing conditions in New Zealand: A descriptive study. J Paediatr Child Health. 2017;53(4):358-64. https://doi.org/10.1111/jpc.13421
  12. Coffey PM, Ralph AP, Krause VL. The role of social determinants of health in the risk and prevention of group A streptococcal infection, acute rheumatic fever and rheumatic heart disease: A systematic review. PLOS Neglected Tropical Diseases. 2018;12(6):e0006577. https://doi.org/10.1371/journal.pntd.0006577
  13. Burke RJ, Chang C. Diagnostic criteria of acute rheumatic fever. Autoimmunity Reviews. 2014;13(4):503-7. https://doi.org/0.1016/j.autrev.2014.01.036
  14. Adam MHM, Ali AGK, Farah AMS, Elamin AME, Mohamed SAA, Hassan MME, et al. Diagnosis and management of acute pharyngotonsillitis among pediatric patients at Ribat Teaching Hospital: A prospective audit (2021-2022). Sudan Journal of Paediatrics. 2023;23(1):4-12. https://doi.org/10.24911/SJP.106- 1650204740
  15. Hurst JR, Shannon BA, Craig HC, Rishi A, Tuffs SW, McCormick JK. The Streptococcus pyogenes hyaluronic acid capsule promotes experimental nasal and skin infection by preventing neutrophil-mediated clearance. PLOS Patho- gens. 2022;18(11):e1011013. https://doi.org/10.1371/journal.ppat.1011013
  16. Beaton A, Carapetis J. The 2015 revision of the Jones criteria for the diagnosis of acute rheumatic fever: Implications for practice in low-income and middle- income countries. Heart Asia. 2015;7(2):7-11. https://doi.org/10.1136/ heartasia-2015-010648
  17. Pekpak E, Atalay S, Karadeniz C, Demir F, Tutar E, Uçar T. Rheumatic silent carditis: Echocardiographic diagnosis and prognosis of long-term follow up. Pediatrica In- ternational. 2013;55(6):685-9. https://doi.org/10.1111/ped.12163
  18. Karthikeyan G, Guilherme L. Acute rheumatic fever. The Lancet. 2018;392(10142):161-74. https://doi.org/10.1016/S0140-6736(18)30999-1
  19. Yavrum BE, Gul AEK, Azak E, Gursu HA, Cetin II. Changing face of acute rheumatic fever in childhood and our clinical results. Northern Clinics of Istanbul. 2023;10(2):237-47. https://doi.org/10.14744/nci.2021.58966
  20. Saini N, Kumar D, Swarnim S, Bhatt D, Kishore S. Comparison of antistreptolysin O and anti-deoxyribonucleic B titers in healthy children to those with acute pharyngitis, acute rheumatic fever, and rheumatic heart disease aged 5-15 years. Ann Ped Card. 2019;12:195-200. https://doi.org/10.4103/apc.APC_60_18
  21. Clark BC, Krishnan A, McCarter R, Scheel J, Sable C, Beaton A. Using a low- risk population to estimate the specificity of the World Heart Federation criteria for the diagnosis of rheumatic heart disease. J Am Soc Echocardiogr. 2016;29(3):253-8. https://doi.org/10.1016/j.echo.2015.11.013
  22. Olsen RJ, Zhu L, Musser JM. A single amino acid replacement in penicillin- binding protein 2x in streptococcus pyogenes significantly increases fitness on subtherapeutic benzylpenicillin treatment in a mouse model of necrotizing myositis. Am J Pathol. 2020;190(8):1625-31. https://doi. org/10.1016/j.ajpath.2020.04.014
  23. Çetin İİ, Ekici F, Kocabaş A, Çevik BŞ, Eminoğlu S, Azak E, et al. The efficacy and safety of naproxen in acute rheumatic fever: The comparative results of 11- year experience with acetylsalicylic acid and naproxen. Turk Journal Pediatrics. 2016;58(5):473-9. https://doi.org/10.24953/turkjped.2016.05.003
  24. Mehta A, Saxena A, Juneja R, Ramakrishnan S, Gupta S, Kothari SS. Characteristics and outcomes of Indian children enrolled in a rheumatic heart disease registry. Int J Card. 2016;222:1136-40. https://doi.org/10.1016/j.ijcard.2016.08.259
  25. Cameli M, Incampo E, Mondillo S. Left atrial deformation: Useful index for early detection of cardiac damage in chronic mitral regurgitation. IJC Heart & Vascula- ture. 2017;17:17-22. https://doi.org/10.1016/j.ijcha.2017.08.003
  26. Simpson MT, Kachel M, Neely RC, Erwin WC, Yasin A, Patel A, et al. Rheumatic heart disease in the developing world. Structural Heart. 2023;7(6):100219. https://doi.org/10.1016/j.shj.2023.100219
  27. Ambari AM, Radi B, Dwiputra B, Arityanti D, Rikl T, Inggriani MP, et al. Adherence to penicillin treatment is essential for effective secondary prevention of rheumatic heart disease: A systematic review and meta-analysis. Ann Med Surg. 2024;86(4):2116-23. https://doi.org/10.1097/MS9.0000000000001833

Authors' information:

Umarova Saodat Sulaymonovna,
Assistant, Department of Pediatrics № 3 and Medical Genetics, Samarkand State Medical University
ORCID ID: 0000-0002-9074-0285
E-mail: saodatumarova86@gmail.com

Mukhamadieva Lola Atamurodovna,
Doctor of Medical Sciences, Professor of the Department of Pediatrics № 3 and Medical Genetics, Samarkand State Medical University
ORCID ID: 0000-0003-1042-9479
E-mail: mlola@bk.ru

Information about support in the form of grants, equipment, medications

The authors did not receive financial support from manufacturers of medicines and medical equipment

Conflicts of interest: No conflict

Address for correspondence:

Umarova Saodat Sulaymonovna
Assistant, Department of Pediatrics № 3 and Medical Genetics, Samarkand State Medical University

140100, Republic of Uzbekistan, Samarkand. Amira Temura str., 18

Tel.: +998 (933) 373800

E-mail: saodatumarova86@gmail.com


This work is licensed under a Creative Commons Attribution 4.0 International License.

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