Acute rheumatic fever and its diagnostic difficulty

Abstract

Objective: To analyze the diagnostic difficulty of acute rheumatic fever (ARF) and its implications as a public health problem. Literature review: ARF is a systemic inflammatory disease generally triggered after pharyngotonsillitis caused by group A β-hemolytic Streptococcus. In Brazil, approximately 10 million cases of pharyngotonsillitis occur each year, with thousands of cases of ARF, of which a proportion progress to carditis and are at risk of developing chronic rheumatic heart disease. Studies indicate an increase in mortality associated, in part, with delayed diagnosis of the disease. Diagnostic difficulties arise from the absence of pathognomonic signs, the lack of specific laboratory tests, and limitations in the knowledge of healthcare teams. Although diagnosis is guided by the Jones Criteria and their 2015 update, clinical interpretation in daily practice remains challenging, favoring underdiagnosis and inadequate patient management. Final considerations: Underdiagnosis of ARF may result in complications with individual and collective repercussions. Strengthening health systems, training professionals, and expanding access to adequate diagnostic methods are essential, aiming at early detection of ARF, reduction of complications, and decrease in public health costs.