CHALLENGES IN DIAGNOSING ACUTE RHEUMATIC FEVER

Abstract

Acute Rheumatic Fever (ARF) is a multisystemic and autoimmune inflammatory sequela resulting from infection with Streptococcus pyogenes (group A streptococcus), and is the leading global cause of cardiovascular morbidity and premature mortality in young people. Diagnosis of ARF is complex due to the absence of a specific and definitive laboratory test, depending on the careful application of the Jones Criteria, which have been updated to incorporate epidemiological nuances. This work consists of a narrative literature review that aims to compile and examine contemporary discussions about the diagnostic challenges of ARF. The results highlight the relevance of the 2015 update of the Jones Criteria, which established differentiated diagnostic thresholds by population risk and became more sensitive in areas of high endemicity. The incorporation of echocardiography in the diagnosis of subclinical carditis is a fundamental pillar, and clinical diversity manifests mainly through migratory polyarthritis and carditis. The pathogenesis is explained by molecular mimicry, and an emerging challenge is the role of skin infections (such as impetigo) as precursors to the disease, in addition to the traditional pharyngitis. The main barriers to effective diagnosis are exacerbated by inequities in access to healthcare. Although research prioritizes the identification of precise biomarkers, such as next-generation sequencing (NGS), the most effective strategies at present involve strengthening disease registries and integrating control programs into primary care, with an emphasis on active surveillance of pharyngitis and skin wounds. Understanding these challenges and early detection are crucial to mitigating permanent valvular damage.