Diagnosis of rheumatic fever: the need for a better test

Acute rheumatic fever (ARF) is a postinfectious immune-mediated syndrome predominantly affecting children, adolescents and young adults following infection with the group A Streptococcus (Streptococcus pyogenes (Strep A). Its clinical presentation is varied, with symptoms, signs and laboratory abnormalities reflecting systemic inflammation (fever, elevated C reactive protein and erythrocyte sedimentation rate) and focal inflammation of the heart (carditis, most frequently manifest as valvulitis), joints (arthritis and arthralgia), skin (subcutaneous nodules, erythema marginatum) and brain (chorea).

Severe acute rheumatic carditis may be fatal, but mortality and morbidity due to the chronic valve lesions of rheumatic heart disease (RHD) are much greater, attributable largely to heart failure and stroke. The lesions of RHD are thought to be caused by recurrent episodes of ARF due to repeated group A streptococcal infections. In the second half of the 20th century, the global burden of ARF shifted dramatically, virtually disappearing from high-income countries to become concentrated in...

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