Which statement about rheumatic fever is TRUE?

Correct answer: D. It follows an oropharyngeal infection with group A beta-hemolytic Streptococcus and can affect the heart and joints

• A. It is NOT a direct infection of the valves — that describes infective endocarditis. Rheumatic fever is immune-mediated, which is why it appears weeks after the throat infection has cleared.
• B. Group A Streptococcus pyogenes is the organism, not Staphylococcus.
• C. It is a multisystem disease; cardiac involvement is what makes it dangerous. 'Rheumatic fever licks the joints but bites the heart.'
• D. CORRECT. Acute rheumatic fever is a delayed AUTOIMMUNE sequela occurring 2–4 weeks after untreated group A beta-hemolytic STREPTOCOCCAL PHARYNGITIS. Antibodies against streptococcal M protein cross-react with human cardiac, joint, skin, and neural tissue (molecular mimicry). The Jones criteria include carditis, migratory polyarthritis, chorea, erythema marginatum, and subcutaneous nodules. Chronic valvular damage — most often MITRAL STENOSIS — is the long-term consequence.

Note: Note the current AHA position: a history of rheumatic fever alone is NOT an indication for antibiotic prophylaxis. Only prosthetic valves, prior endocarditis, certain congenital heart disease, and cardiac transplant valvulopathy qualify.