Acute rheumatic fever is an inflammatory disease triggered by infection with group A streptococcus bacteria. Recurring or lengthy bouts of rheumatic fever can lead to rheumatic heart disease, causing permanent heart damage.

Acute rheumatic fever is a significant cause of illness in Aboriginal and Torres Strait Islander Australians. Our goal is to improve how rheumatic fever is diagnosed and treated.

Our rheumatic fever research

Our rheumatic fever research program aims to:

• Understand the causes of inflammation and autoimmune attack in acute rheumatic fever.
• Develop new diagnostic tools and treatments to improve the outlook for people with acute rheumatic fever.

Our research benefits from collaborations with our researchers working on other inflammatory diseases. We also work closely with rheumatic fever researchers at other organisations including:

• Menzies School of Health Research
• Telethon Institute for Child Health Research
• Centre for International Child Health at The Royal Children's Hospital
• The University of Oxford

What is rheumatic fever?

Acute rheumatic fever is an autoimmune disease that occurs after infection with bacteria called group A streptococci. These bacteria typically cause throat or skin infections, which can be treated with antibiotics.

In some people, particularly children, the immune cells responding to the bacterial infection mistakenly attack the body’s own tissues, causing inflammation in the:

• Heart, particularly the valves
• Brain
• Joints
• Skin

Acute rheumatic fever is often a serious disease warranting hospitalisation. The immune attack on the heart can cause scarring and permanent damage, a condition called rheumatic heart disease.

People who have had acute rheumatic fever are at greater risk of developing the disease again. Every occurrence of the disease increases the amount of heart damage. In the long term, rheumatic heart disease can cause heart failure.

In Australia, acute rheumatic fever is most prevalent in Aboriginal and Torres Strait Islander peoples, particularly children living in remote communities. Rheumatic heart disease is a significant cause of illness and death in young adults in these communities.

Rheumatic fever and rheumatic heart disease are also a serious global health burden, causing more than 300,000 deaths annually. Worldwide, rheumatic heart disease is the most common form of heart disease in children.

Risk factors for acute rheumatic fever and rheumatic heart disease

Acute rheumatic fever occurs in people who have been infected with group A streptococcal bacteria. However, only a small percentage of people infected with this bacterium go on to develop acute rheumatic fever.

Factors increasing a person’s likelihood of developing acute rheumatic fever include:

• Limited access to medical care: delayed treatment of group A streptococcal infections increases the chance of developing acute rheumatic fever.
• Age: children are more likely to contract the infection, and also to subsequently develop acute rheumatic fever.
• Genetic factors: some people, including Aboriginal and Torres Strait Islander peoples, appear to have a tendency to develop inflammatory diseases.
• Living in overcrowded conditions, and poor hygiene, which can increase the chances of developing group A streptococcal infections of the skin.
• Scabies, which may increase susceptibility to bacterial skin infections.
• Previous acute rheumatic fever episodes, which ‘prime’ the immune system to cause the disease again.

How is acute rheumatic fever treated?

Preventing and treating acute rheumatic fever relies on:

• Treating group A streptococcal infections: early treatment with antibiotics reduces the chance that someone will go on to develop acute rheumatic fever.
• Reducing inflammation: anti-inflammatory medications will reduce the severity of symptoms of acute rheumatic fever.

People who have had acute rheumatic fever previously are at risk of the disease occurring again. Screening for group A streptococcal infections and early antibiotic treatment can reduce the disease recurrence.

The heart valve damage caused by rheumatic heart disease is permanent and may need surgical repair.