Mamun Ur Rahman, Ashur Khan, Waqar Ahmed, Muhammad Bilal Bin Yousaf, Muhammad Yousaf.
Rheumatic Fever - an update.
Pak Armed Forces Med J Jan ;45(2):76-82.

Rheumatic fever continues to remain an important cause of mortality and morbidity in the world, particularly in the developing countries. An autoimmune reaction following antecedent infection with rheumatogenic group A streptococci is implicated in the pathogenesis of acute rheumatic fever. However, the exact pathogenetic mechanisms are still unknown. Immunological cross reactions between group A streptococcal antigens and human tissues, genetic susceptibility determined by HLA DR locus, abnormal cellular and humoral responses have all been implicated. The diagnosis of acute rheumatic fever is based on clinical manifestations supported by laboratory evidences of antecedent group A streptococcal infection. Other diseases which have some of the clinical features in common should be carefully excluded. Treatment is directed towards elimination of streptococcal infection, control of arthritis by salicylates, treatment of heart failure (when present) and prevention of reinfection by continuous antimicrobial prophylaxis. The natural course of the disease can hardly be altered by available treatment. Preventive measures, both primary and secondary, are important in view of the risk of developing rheumatic valvular heart disease with reccurent attacks of carditis.

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