Background: Acute rheumatic fever (ARF) is a significant public health concern in resource-limited settings, but its clinical presentation remains inadequately described. This study leverages data from the ARF Diagnostic (ARC) Network to provide a global overview of ARF characteristics.
Methods: Children aged 3–18 years from Brazil, Malawi, Pakistan, and Timor-Leste were enrolled based on clinical signs of joint pain, suspected rheumatic carditis, chorea, or known rheumatic heart disease (RHD) with suspected ARF recurrence. A standardized enrollment protocol was used across all sites.
Results: A total of 128 children with ARF were included: Brazil (n=9), Malawi (n=22), Pakistan (n=86), and Timor-Leste (n=11). The median age was 10 years (IQR: 9–12), with 46% female. Slightly more than two-thirds (72%) of ARF cases were thought to be first-episode with known recurrence in 28% of cases. The breakdown of major manifestations among these cases included 40% with joint symptoms (7 polyarthritis, 41 polyarthralgia, 4 monoarthritis), 106 carditis (81 moderate/severe, 25 mild), 4 subcutaneous nodules, erythema marginatum, and 25% with chorea. The percentage of patients with various major presentations varied between sites, with 44% of patients in Brazil presenting with chorea, 68% with carditis in Pakistan and 50% and 82% with joint manifestations in Malawi and Timor respectively.
Conclusion: These findings highlight regional variation in ARF manifestations and the need for improved diagnostic and management strategies in high-burden areas. It remains unclear whether differences in clinical presentation reflect variations in care-seeking behavior or true disease prevalence.