Clinical characteristics and predictors of adverse outcomes in children with acute rheumatic fever from a high-endemic region of Brazil - Scorecard - MDSpire

Clinical characteristics and predictors of adverse outcomes in children with acute rheumatic fever from a high-endemic region of Brazil

  • By

  • Renata Fonseca Mendoza

  • Letícia Leão de Oliveira

  • Bernardo Fonseca Mendoza

  • Jose Luiz Padilha da Silva

  • Paulo Henrique M. Melo

  • José Augusto Almeida Barbosa

  • Géssica Silva Santana

  • Airandes Pinto

  • Ndate Fall

  • Andrea Beaton

  • Maria Carmo Pereira Nunes

  • June 10, 2026

  • 0 min

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Clinical Scorecard: Clinical Features and Risk Factors for Negative Outcomes in Pediatric Acute Rheumatic Fever in a High-Endemic Area of Brazil

At a Glance

CategoryDetail
ConditionAcute Rheumatic Fever (ARF)
Key MechanismsTriggered by group A Streptococcus infection, leading to autoimmune inflammatory responses and potential progression to rheumatic heart disease (RHD).
Target PopulationChildren diagnosed with ARF in a high-endemic region of Brazil.
Care SettingTertiary pediatric referral center.

Key Highlights

  • 76% of children presented with carditis, 49% with moderate-to-severe involvement.
  • 20 children (13%) experienced adverse outcomes (cardiac surgery or death) during follow-up.
  • Absence of fever, higher ESR, and lower hematocrit were identified as independent predictors of adverse outcomes.
  • Incorporating ESR improved risk prediction significantly.
  • The final model demonstrated good discrimination with a C-statistic of 0.82.

Guideline-Based Recommendations

Diagnosis

  • Diagnosis of ARF established according to Jones criteria.
  • Evidence of preceding group A Streptococcus infection based on clinical history and/or elevated ASO titers.

Management

  • Timely management and referral for children at highest risk for adverse outcomes.

Monitoring & Follow-up

  • Regular follow-up to assess cardiac involvement and progression.

Risks

  • Moderate to severe carditis is a powerful predictor of long-term morbidity and mortality.

Patient & Prescribing Data

Children treated for ARF at a tertiary pediatric center in Feira de Santana, Brazil.

Simple inflammatory and hematologic markers can aid in identifying children at risk for severe outcomes.

Clinical Best Practices

  • Utilize inexpensive and widely accessible tests like ESR for risk stratification.
  • Early identification of ARF is crucial to prevent progression to severe RHD.

Related Resources & Content

Original Source(s)

Clinical characteristics and predictors of adverse outcomes in children with acute rheumatic fever from a high-endemic region of Brazil

  • by Renata Fonseca Mendoza, Letícia Leão de Oliveira, Bernardo Fonseca Mendoza, Jose Luiz Padilha da Silva, Paulo Henrique M. Melo, José Augusto Almeida Barbosa, Géssica Silva Santana, Airandes Pinto, Ndate Fall, Andrea Beaton, Maria Carmo Pereira Nunes

  • June 10, 2026

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