The resurgence of acute rheumatic fever in the United States.

Several areas in the United States have experienced significant outbreaks of acute rheumatic fever. Reasons for the reappearance of acute rheumatic fever are incompletely understood but may relate to changes in the organism. Fortunately, however, GABHS has remained exquisitely susceptible to penicillin. Given the resurgence in cases of acute rheumatic fever, the practicing physician needs to be vigilant in diagnosing and ensuring adequate treatment of acute streptococcal pharyngitis. In addition, acute rheumatic fever must be considered in a patient who presents with a new onset murmur, a migratory polyarthritis, chorea, or a rash suggestive of erythema marginatum.