Can rheumatic fever be preceded by an upper respiratory infection, specifically group A streptococcal (GAS) pharyngitis?

From the Guidelines

Rheumatic fever can indeed be preceded by an upper respiratory infection, specifically group A streptococcal (GAS) pharyngitis. The connection between GAS pharyngitis and rheumatic fever is well-established, with rheumatic fever developing as a delayed autoimmune response to the streptococcal infection 1. Key points to consider include:

• The importance of proper identification and adequate antibiotic treatment of GAS tonsillopharyngitis to prevent acute rheumatic fever 1
• The use of penicillin as the treatment of choice for GAS pharyngitis, due to its cost-effectiveness, narrow spectrum of activity, and proven efficacy 1
• The need for continuous antimicrobial prophylaxis in individuals who have had an attack of rheumatic fever to prevent recurrences 1
• The recommended duration of prophylaxis depends on various factors, including the number of previous attacks, time elapsed since the last attack, and risk of exposure to GAS infections 1. It is crucial to treat GAS pharyngitis promptly and adequately to prevent the development of rheumatic fever, which can have serious consequences on morbidity, mortality, and quality of life.

From the Research

Rheumatic Fever and Upper Respiratory Infection

• Rheumatic fever can be preceded by an upper respiratory infection, specifically group A streptococcal (GAS) pharyngitis 2, 3, 4, 5.
• The infection typically occurs 2 to 4 weeks before the onset of rheumatic fever symptoms 2.
• GAS pharyngitis is a common trigger for rheumatic fever, and proper identification and treatment of the infection are crucial for preventing the development of rheumatic fever 3, 5.

Prevention and Treatment

• Penicillin is the primary treatment for GAS pharyngitis and is also used for secondary prophylaxis to prevent recurrent episodes of rheumatic fever 2, 3, 6, 5.
• Other antibiotics, such as macrolides and cephalosporins, may be used as alternatives in penicillin-allergic individuals 3.
• Anti-inflammatory agents may provide symptomatic relief but do not prevent rheumatic heart disease 5.

Relationship Between GAS Pharyngitis and Rheumatic Fever

• The relationship between GAS pharyngitis and rheumatic fever is well-established, with GAS pharyngitis being a common precursor to rheumatic fever 2, 3, 4, 5.
• The autoimmune response to GAS pharyngitis can lead to the development of rheumatic fever and subsequent rheumatic heart disease 4.