Acute rheumatic fever (ARF) was recognized initially in the late 19th century and followed a declining pattern of incidence in the United States until the mid-1980s. It remains one of the primary causes of acquired heart disease worldwide. A resurgence of ARF since 1984 prompted the medical community to review the early signs and symptoms of an illness that was considered to be uncommon. Traditionally,ARF was thought to be a disease of the inner-city poor and military recruits, but in recent resurgences,rural and suburban communities have been affected as well.

The most common clinical manifestations of ARF in recent outbreaks in the United States were arthritis and carditis. During these outbreaks the majority of patients showed one major manifestation,but two major manifestations(carditis and arthritis or carditis and chorea) also were seen frequently. Many of the patients diagnosed as having ARF during these epidemics had no recognizable prodrome that would have...

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