ARF is caused by an autoimmune reaction to an untreated or inadequately treated infection with GAS. In temperate climates, it was thought that GAS pharyngitis was solely responsible for ARF. The epidemiology of ARF in Australia (particularly in aboriginal communities), however, suggests a different etiology. In communities with a high prevalence of ARF, GAS throat colonization is rare, and pyoderma is the primary manifestation of GAS infection.8
The onset of ARF usually occurs approximately 2 to 3 weeks following the initial GAS infection and can present with a multitude of symptoms, including: carditis, arthritis, chorea, erythema marginatum, and subcutaneous nodules. By the time these symptoms present, the host has typically eradicated the GAS infection.6
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