Determining risk of acute rheumatic fever in patients with pharyngitis and tonsillitis

For the common syndromes of viral or streptococcal pharyngitis and tonsillitis, the approach to management depends on the patient’s risk of acute rheumatic fever. For the approach to managing patients at high risk of acute rheumatic fever, see here and for the approach to managing patients not at high risk of acute rheumatic fever, see here.

An individual is at high risk of developing acute rheumatic fever if they are younger than 40 years and any one of the followingRHDAustralia (ARF/RHD writing group), 2020:

  • an Aboriginal and/or Torres Strait Islander person living in a rural or remote area
  • an Aboriginal and/or Torres Strait Islander person, or a Māori and/or Pacific person, living in a household affected by overcrowding or experiencing socioeconomic disadvantage
  • a person with a history of acute rheumatic fever or rheumatic heart disease
  • part of a family or household in which a member has a recent history of acute rheumatic fever or rheumatic heart disease.

For individuals younger than 40 years, but particularly between 5 and 20 years, other factors that could put them at high risk of developing acute rheumatic fever includeRHDAustralia (ARF/RHD writing group), 2020:

  • living in a household affected by overcrowding and experiencing socioeconomic disadvantage
  • current or prior residence in, or frequent or recent travel to, an Australian setting with a high rate of acute rheumatic fever1
  • current or prior residence in, or frequent or recent travel to, an international setting with a high rate of acute rheumatic fever (eg refugees, migrants)2.

For patients with these factors, clinical judgement is needed to determine if the individual is at high risk of acute rheumatic fever for the purpose of primary prevention in the management of sore throat. This assessment should take into account the clinician’s knowledge of the patient (including travel history), understanding of their communities, and local epidemiology.

For discussion on the epidemiology of acute rheumatic fever, including the relevance of social determinants of health to the risk of acute rheumatic fever, see Introduction to acute rheumatic fever.

1 In Australia, acute rheumatic fever is generally considered to be endemic in Far North Queensland and North Queensland, the Northern Territory, and the Pilbara and Kimberley regions of Western Australia; acute rheumatic fever rates may also be high in other remote areas of AustraliaKatzenellenbogen, 2020.Return
2 Internationally, high rates of acute rheumatic fever occur in low- to middle-income countriesRHDAustralia (ARF/RHD writing group), 2020.Return