Be alert for Acute Rheumatic Fever (ARF)

23 October 2025

  • There continues to be an increased number of cases of ARF in 2025 on the Eyre Peninsula.
  • ARF is a systemic illness caused by an autoimmune response to a Group A streptococcus (GAS) infection. Infection with GAS may cause sore throat, tonsilitis and skin infections. In some cases, GAS infection will trigger ARF, which typically occurs 2-3 weeks after a GAS infection. ARF is most common in children aged 5-14 years but can also occur in adults.
  • Prompt treatment of GAS infections with antibiotics in high-risk groups is crucial to prevent an episode of ARF and consequential heart damage, known as rheumatic heart disease (RHD).
  • Doctors, nurses and Aboriginal health practitioners (AHP) across the state, but particularly in the Eyre and Far North (PDF 129KB) health district are reminded to be alert for GAS, ARF and RHD.

Clinicians are advised to:

  • Be aware of the high-risk groups for ARF in South Australia (SA):
    • Those living in an ARF-endemic setting (in SA, this is the APY Lands).
    • Aboriginal or Torres Strait Islander peoples living in rural or remote settings.
    • Aboriginal and/or Torres Strait Islander peoples, and Māori and/or Pacific Islander peoples living in housing that impacts infection prevention and control and/or socioeconomic disadvantage.
    • People with a known history of ARF/RHD aged <40 years on secondary prophylaxis.
  • Consider ARF in other risk groups e.g., family/household with a recent history of ARF/RHD, housing that impacts infection prevention and control (>2 people per bedroom), socioeconomic disadvantage, migrant/refugees from low or middle-income country and their children.
  • Be alert for GAS sore throat and skin sores in those at high-risk of ARF.  
  • Swab affected area (throat/skin MC&S) for GAS in persons in high-risk groups.
  • Consider alternative diagnoses and request appropriate testing for respiratory pathogens and other causes of polyarthralgia.
  • Treat empirically persons in high-risk groups with suspected GAS throat/skin infection:
  • Give a single dose of intramuscular (IM) benzathine benzylpenicillin G (unless contraindicated). Where IM injection is not possible, azithromycin is the first line oral treatment of GAS sore throat, see the Australian guideline for the prevention, diagnosis and management of ARF and RHD (ARF/RHD guideline p 54-55) (Note – Azithromycin is not listed on the PBS for this indication).
  • See advice on current benzathine benzylpenicillin shortage in benzathine benzylpenicillin health alert at TGA.
  • Ensure people with existing ARF/RHD are up to date with secondary prophylaxis and that treatment information is sent through to the SA Health RHD Register.
  • Note information on RHD and the RHD Register is available at www.sahealth.sa.gov.au/RHD.

Medical practitioners should investigate suspected ARF:

  • Consider ARF in high-risk groups when:
    • Joint pain and/or swelling is present in one or more large joints.
    • There is a history (documented or reported) of fever >38°C.
    • Chorea is present - jerky, uncoordinated movements affecting the hands, feet and tongue.
    • A new murmur is detected - although echocardiography will identify subclinical carditis.
    • Other cardiac symptoms are present - dyspnoea, chest pain, palpitations, fatigue.
    • See ARF/RHD guideline (p 68) for a complete list of signs/symptoms.
  • Request Strep serology (ASOT), FBC, ESR, CRP, throat/skin swab for MC&S, and electrocardiogram.
  • Seek prompt advice from a cardiologist & send the patient to hospital as per ARF/RHD guideline p 70.
  • Ask about a history of ARF or RHD (individual or family).
  • Commence any patient with suspected ARF on IM benzathine benzylpenicillin G prophylaxis (unless contraindicated) while awaiting cardiology review. See ARF/RHD guideline (p 96-7).
  • Notify CDCB of suspected or confirmed cases of ARF or RHD.

Dr Louise Flood – Medical Lead, Communicable Disease Control Branch