Renny Suwarniaty, MD
Departement of Pediatric, University of Brawijaya, Malang, Indonesia
E-mail : firstname.lastname@example.org
Acute Rheumatic Fever (ARF) is a disease caused by a Group A beta-hemolyitic streptococci (GABHS) infection which then involves a slow immunological response (Siregar, 2008) In some circumstances, further ARF can trigger Rheumatic Heart Disease (RHD), which result in irreversible valve damage and heart failure (Marijon Eloy, 2012). Valve damage in RHD is the most common Acquired Heart Disease causing mortality and morbidity in Children in Developing Countries, resulted in 250,000 deaths each year. In a systematic review study, it was reported that 471,000 cases of ARF occurred every year, with an incidence around 336,000 children aged 5-14 year old. And it is also reported that 350,000 children died every year due to ARF and RHD, and the majority occurred in low and middle income countries (Carapetis, et al. 2016).
As we know, the spread of streptococcal infection is through droplets and facilitated by population density. Environmental factors also contribute to the incidence of ARF, and the prevalence of RHD is also influenced by dense settlements, urbanization, social-economic status, poor nutrition and difficult access to health facilities. (Carapetis et al, 2005)
The incidence of RHD in Indonesia is still unknown. The latest data has shown that ARF in Indonesia (1981-1990) were 0.3-0.8 among 1,000 school-age children. (Siregar, 2008)
In susceptible individuals, ARF occurs 6-10 days after Pharyngeal GABHS infection. (Smith et al, 2012). Symptoms of ARF are Cardiac and Non Cardiac, and divided into major and minor symptoms. The major symptoms includes: Carditis, Arthritis, Chorea Sydenham, Erythema Marginatum, Subcutaneous Nodules, and the Minor symptoms includes: Atralgia, Fever, Prolonged PR interval, and increase in Acute Phase Reactants. (Madiyono et al, 2009)
The management of acute rheumatic fever includes: Primary prophylaxis (germ eradication), anti-inflammatory, supportive therapy, and secondary prophylaxis. Antibiotic is used as primary and secondary prophylaxis, and Penicillin is the primary recommended choice.
This paper discuss the role of antibiotics in Acute Rheumatic Fever and Rheumatic Heart Disease.
Carapetis JR, Andrea B, Cunningham MW, Guilherme L, Karthikeyan G, Mayosi BM, Sable C, Steer A, Wilson N, Wyber R, Zuhlke L. Acute Rheumatic Fever and Rheumatic Heart Disease. Nature Reviews Disease Primers Volume 2, 2016;15084.
Ciliers AM. Rheumatic Fever and Its Management. BMJ 2006; 333 (7579): 1153 - 1156.
Madiyono B, Sukardi R, Kuswiyanto RB. Demam Rematik dan Penyakit Jantung Rematik pada Anak. In: Management of Pediatric Heart Diseases for Practitioners: From Early Detection to Invertion, Departemen Ilmu Kesehatan Anak FKUI-RSCM. 2009. p. 95-114.
Viswanathan AJ, Vijayalakshmi IB. Acute Rheumatic Fever. Indian Journal of Rheumatology. 2012. 7(1): 36 - 43.
WHO. Rheumatic Fever and Rheumatic Heart Disease. Report of a WHO study Group. Tchinical Repoert Series. Geneva. 2011; No. 923.
Zuhlke LJ, Veaton A, Engel C, Ganesan, et al. Group A Streptococcus, Acute Rheumatic Fever and Rheumatic Heart Disease: Epidemiology and Clinical Consideration. In Current Treatment options in Cardiovascular Medicine. February, 2017.