Can Acute Rheumatic Fever and APSGN co exist?

- Coexistence of ARF and APSGN is rarely occur. Only few reported case being publish. Incidence of APSGN with ARF were found as 0.7% and 1.3%.

- Both are due to Group A Streptococcal infection but both organ system involvement is not due to the direct invasion with the microorganism but rather due to immunologically mediated

- ARF only occurs following group A streptococcal infection of upper respiratory tract while APSGN occur following either pharyngeal or cutaneous infection

- Epidemiological survey shows that nephritogenic strains of streptococci (e.g. types 12, 49) do not cause ARF and rheumatogenic strains do not lead to nephritis

- However patient with ARF would be at risk for APSGN after throat infection due to one of these nephritogenic strains.

- In the reported case, it is noted that ARF was generally the presenting feature which then followed with glomerulonephritis.

- Presence of one or more gross and microscopic hematuria, hypertension, low C3 level and oliguria in a patient with ARF should alert the physician to suspect ARF co-existent with APSGN

Reference:

Hamit Ozyurek, Ayten P. Uyan,Sabriye Korkut & Kenan Kocabay, "Can Acute Rheumatic Fever and Acute Poststreptococcal Glomerulonephritis Occur Simultaneously?", International Pediatrics/Vol. 17/No. 3/2002