Febre reumática aguda: manifestações clínicas e diagnóstico

Abstract

Introduction: Acute rheumatic fever (ARF) is a non-suppurative sequela that occurs two to four weeks after group A Streptococcus (GAS) pharyngitis and may consist of arthritis, carditis, chorea, erythema marginatum, and subcutaneous nodules. Damage to the heart valves may be chronic and progressive, resulting in cardiac decompensation. Objective: to discuss acute rheumatic fever: clinical manifestations and diagnosis. Methodology: Literature review from Scielo, PubMed, and BVS databases, from January to April 2024, with descriptors “Acute rheumatic fever”, “Clinical manifestations”, and “Diagnosis”. Articles from 2019-2024 (total 51) were included, excluding other criteria and choosing 05 full articles. Results and Discussion: Acute rheumatic fever (ARF) is a nonsuppurative sequela of group A Streptococcus (GAS) pharyngitis that occurs 2 to 4 weeks after infection. The five major manifestations (major Jones criteria) of ARF are migratory arthritis (predominantly involving large joints), carditis and valvulitis (eg, pancarditis), central nervous system involvement (eg, Sydenham chorea), erythema marginatum, and subcutaneous nodules. The four minor manifestations (minor Jones criteria) are arthralgia, fever, elevated acute-phase reactants, and prolonged PR interval on electrocardiogram. The diagnosis of ARF is made on clinical grounds. The likelihood of ARF is high in the setting of GAS infection followed by two major criteria or one major and two minor criteria. The criteria are modified slightly for patients in moderate- to high-risk populations. The differential diagnosis of polyarticular joint pain in childrenand adults is broad and includes other causes, such as infection, postinfectious immunologic reactions, autoimmune or autoinflammatory disease, malignancy, and other systemic diseases. Some cases of arthritis that occur after a streptococcal infection are not accompanied by sufficient additional Jones Criteria to meet the diagnostic requirements for ARI. This disorder has been termed poststreptococcal reactive arthritis (PSRA). Conclusion: Rheumatic fever is a reaction to a throat infection with a bacterium known as streptococcus. This throat infection is characterized clinically by fever, sore throat, lumps in the neck (enlarged glands), and intense redness, red spots, or patches of pus in the throat.