Which of the following applies to acute rheumatic fever?

Which of the following applies to acute rheumatic fever?

• A. Symptoms begin after S. pyogenes infection of the throat or the skin.
• B. Antibodies to Group A streptococci are believed to cross-react with heart tissue.
• C. Diagnosis is usually made by culture of the organism.
• D. All patients suffer permanent disability.

Answer: (D)

Acute rheumatic fever is a delayed, immune-mediated reaction that can follow infection with Streptococcus pyogenes, most often after a throat infection and less commonly after a skin infection. The key idea is that antibodies (and T cells) generated against GAS antigens—especially the M protein—cross-react with heart tissue and other tissues, leading to inflammatory damage such as carditis, arthritis, and sometimes chorea. Diagnosis isn’t based on finding the organism in culture at the time of ARF; instead, it relies on clinical criteria (Jones criteria) plus evidence of a prior GAS infection (for example, a rising or high anti-streptolysin O titer or anti-DNase B, or documented recent GAS infection). Importantly, permanent disability does not occur in all patients—many recover fully with treatment and appropriate preventive care, though some may go on to develop chronic rheumatic heart disease.

Acute rheumatic fever is a delayed, immune-mediated reaction that can follow infection with Streptococcus pyogenes, most often after a throat infection and less commonly after a skin infection. The key idea is that antibodies (and T cells) generated against GAS antigens—especially the M protein—cross-react with heart tissue and other tissues, leading to inflammatory damage such as carditis, arthritis, and sometimes chorea. Diagnosis isn’t based on finding the organism in culture at the time of ARF; instead, it relies on clinical criteria (Jones criteria) plus evidence of a prior GAS infection (for example, a rising or high anti-streptolysin O titer or anti-DNase B, or documented recent GAS infection). Importantly, permanent disability does not occur in all patients—many recover fully with treatment and appropriate preventive care, though some may go on to develop chronic rheumatic heart disease.