Contemporary Clinical Characteristics and Presentation of ARF Globally

first_page Download PDF settings Order Article Reprints Font Type: Arial Georgia Verdana Font Size: Aa Aa Aa Line Spacing:    Column Width:    Background: Open AccessAbstract Contemporary Clinical Characteristics and Presentation of ARF Globally † by Omeir AzizOmeir Aziz SciProfiles Scilit Preprints.org Google Scholar 1,*, Tehmina KazmiTehmina Kazmi SciProfiles Scilit Preprints.org Google Scholar 1, Humera JavedHumera Javed SciProfiles Scilit Preprints.org Google Scholar 1, Ndate FallNdate Fall SciProfiles Scilit Preprints.org Google Scholar 2 and Masood SadiqMasood Sadiq SciProfiles Scilit Preprints.org Google Scholar 1 1 University of Child Health Sciences, The Children's Hospital Lahore, Lahore 54600, Pakistan 2 Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH 45229, USA * Author to whom correspondence should be addressed. † Presented at the 22nd Lancefield International Symposium on Streptococci and Streptococcal Diseases, Brisbane, Australia, 1–5 June 2025. Proceedings 2025, 124(1), 15; https://doi.org/10.3390/proceedings2025124015 Published: 13 August 2025 (This article belongs to the Proceedings of The 22nd Lancefield International Symposium on Streptococci and Streptococcal Diseases (LISSSD 2025)) Download keyboard_arrow_down Download PDF Download PDF with Cover Download XML Download Epub Versions Notes Keywords: acute rheumatic fever; rheumatic heart disease; carditis; polyarthralgia; chorea; subcutaneous nodules; erythema marginatum; pediatric cardiology; global health; diagnostic variation 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 202 children with definite ARF were included: Brazil (n = 17), Malawi (n = 36), Pakistan (n = 129), and Timor-Leste (n = 20). Most cases (93%) occurred within the 5–14-year-old-age group, with site-specific median ages ranging from 8 to 11 years. Males comprised 57% of the cohort. First-episode ARF accounted for 74% of cases, while 26% were recurrent episodes. The breakdown of major manifestations among these cases included 72% with joint symptoms (5.5% polyarthritis, 90% polyarthralgia, 4% monoarthritis), 82% with carditis (77% moderate/severe, 23% mild), 2.5% with subcutaneous nodules, 0.5% with erythema marginatum, and 22% with chorea. Regional variation was notable: 47% of Brazilian patients presented with chorea, 83% had carditis in Pakistan, and joint involvement was common in Malawi (78%) and Timor-Leste (90%).Conclusions: 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. Author ContributionsConceptualization, O.A. and M.S.; methodology, O.A.; validation, T.K., H.J. and N.F.; formal analysis, O.A.; investigation, O.A.; resources, N.F.; data curation, O.A.; writing—original draft preparation, O.A.; writing—review and editing, O.A., M.S., T.K., H.J. and N.F.; visualization, O.A. and M.S.; supervision, M.S.; project administration, M.S. All authors have read and agreed to the published version of the manuscript.FundingThis study was conducted under the infrastructure of the ARC network that is funded by Leducq Foundation.Institutional Review Board StatementThe study was conducted in accordance with the Declaration of Helsinki and approved by the Institutional Review Boards of Brazil, Malawi, Pakistan, and Timor-Leste.Informed Consent StatementInformed consent was obtained from all subjects involved in the study. For participants under the age of 18 years, consent was obtained from a parent or guardian.Data Availability StatementData are available on request from the corresponding author. The data are not publicly available due to privacy or ethical restrictions.Conflicts of InterestThe authors declare no conflict of interest.Disclaimer/Publisher's Note: The statements, opinions and data contained in all publications are solely those of the individual author(s) and contributor(s) and not of MDPI and/or the editor(s). MDPI and/or the editor(s) disclaim responsibility for any injury to people or property resulting from any ideas, methods, instructions or products referred to in the content. © 2025 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/). Share and Cite MDPI and ACS Style Aziz, O.; Kazmi, T.; Javed, H.; Fall, N.; Sadiq, M. Contemporary Clinical Characteristics and Presentation of ARF Globally. Proceedings 2025, 124, 15. https://doi.org/10.3390/proceedings2025124015 AMA Style Aziz O, Kazmi T, Javed H, Fall N, Sadiq M. Contemporary Clinical Characteristics and Presentation of ARF Globally. Proceedings. 2025; 124(1):15. https://doi.org/10.3390/proceedings2025124015 Chicago/Turabian Style Aziz, Omeir, Tehmina Kazmi, Humera Javed, Ndate Fall, and Masood Sadiq. 2025. "Contemporary Clinical Characteristics and Presentation of ARF Globally" Proceedings 124, no. 1: 15. https://doi.org/10.3390/proceedings2025124015 APA Style Aziz, O., Kazmi, T., Javed, H., Fall, N., & Sadiq, M. (2025). Contemporary Clinical Characteristics and Presentation of ARF Globally. 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