{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,27]],"date-time":"2026-07-27T17:21:36Z","timestamp":1785172896233,"version":"3.55.0"},"reference-count":20,"publisher":"MDPI AG","issue":"4","license":[{"start":{"date-parts":[[2026,7,27]],"date-time":"2026-07-27T00:00:00Z","timestamp":1785110400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Infect. Dis. Rep.","Infectious Disease Reports"],"abstract":"<jats:p>Background: Acute rheumatic fever (ARF) is a clinical syndrome triggered by group A streptococcal (GAS) infections and characterized by fever, carditis, and arthritis as its main manifestations. Diagnosis relies on the revised Jones criteria. We report a rare case of ARF diagnosed in Switzerland. Case Presentation: An 18-year-old woman presented to the emergency department five days after returning from a one-week stay in Egypt with intermittent fever and a transient sore throat, followed by migratory joint pain. Laboratory testing revealed leukocytosis, elevated C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR). Chest X-ray, urine analysis, and (travel-associated) pathogen-testing (Epstein\u2013Barr virus, Cytomegalovirus, human immunodeficiency virus, Malaria, Dengue, Zika, Chikungunya) were unremarkable. Blood cultures remained negative. Initially, a viral respiratory infection was suspected and symptomatic treatment established. Days later the patient was re-evaluated due to persistent symptoms. Leukocyte count (Lc) and CRP further increased and subcutaneous nodules appeared. The antistreptolysin-O (ASO)-titer was elevated more than three times higher than the normal upper limit and proofed serological evidence of a preceding streptococcal infection (GAS throat culture had not been performed). ARF was diagnosed according to the Jones criteria. Treatment with amoxicillin and a high dose of acetylsalicylic acid (ASA) led to a rapid clinical improvement. Secondary prophylaxis with depot penicillin (benzathine penicillin G; 1.2 million units; once monthly) was initiated to prevent rheumatic heart disease. Conclusions: This case highlights a rare occurrence of ARF following travel to Egypt, with probable acquisition of group A streptococcal infection during the trip. It emphasizes consideration of ARF even in Western countries with low ARF-prevalence if clinical history is suggestive. Early recognition and initiation of antimicrobial and anti-inflammatory therapy is crucial to prevent cardiac involvement. To the best of our knowledge, this represents one of the first cases diagnosed in Switzerland in the past 20 years.<\/jats:p>","DOI":"10.3390\/idr18040079","type":"journal-article","created":{"date-parts":[[2026,7,27]],"date-time":"2026-07-27T16:11:56Z","timestamp":1785168716000},"page":"79","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["A Rare Case of Acute Rheumatic Fever Diagnosed After Recent Travel Abroad"],"prefix":"10.3390","volume":"18","author":[{"given":"Debora","family":"Agreiter","sequence":"first","affiliation":[{"name":"Department of Internal Medicine, Hospital Walenstadt, 8880 Walenstadt, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-7673-3251","authenticated-orcid":false,"given":"Stefan","family":"Fuchs","sequence":"additional","affiliation":[{"name":"Department of Hematology, Cantonal Hospital of Graub\u00fcnden, 7000 Chur, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-3223-1954","authenticated-orcid":false,"given":"Franziska","family":"Marti","sequence":"additional","affiliation":[{"name":"Department of Infectiology, Cantonal Hospital of Graub\u00fcnden, 7000 Chur, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,7,27]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"161","DOI":"10.1016\/S0140-6736(18)30999-1","article-title":"Acute rheumatic fever","volume":"392","author":"Karthikeyan","year":"2018","journal-title":"Lancet"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"2164","DOI":"10.1016\/S0140-6736(25)00185-0","article-title":"Acute rheumatic fever","volume":"405","author":"Hirani","year":"2025","journal-title":"Lancet"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"264","DOI":"10.1128\/CMR.00101-13","article-title":"Disease manifestations and pathogenic mechanisms of Group A Streptococcus","volume":"27","author":"Walker","year":"2014","journal-title":"Clin. Microbiol. Rev."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"481","DOI":"10.1001\/jama.1944.02850430015005","article-title":"The diagnosis of rheumatic fever","volume":"126","author":"Jones","year":"1944","journal-title":"J. Am. Med. Assoc."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"1806","DOI":"10.1161\/CIR.0000000000000205","article-title":"Revision of the Jones Criteria for the diagnosis of acute rheumatic fever in the era of Doppler echocardiography: A scientific statement from the American Heart Association","volume":"131","author":"Gewitz","year":"2015","journal-title":"Circulation"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"67","DOI":"10.2147\/CLEP.S12977","article-title":"The worldwide epidemiology of acute rheumatic fever and rheumatic heart disease","volume":"3","author":"Seckeler","year":"2011","journal-title":"Clin. Epidemiol."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"448","DOI":"10.1086\/499817","article-title":"Changing epidemiology of acute rheumatic fever in the United States","volume":"42","author":"Lee","year":"2006","journal-title":"Clin. Infect. Dis."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"713","DOI":"10.1056\/NEJMoa1603693","article-title":"Global, Regional, and National Burden of Rheumatic Heart Disease, 1990\u20132015","volume":"377","author":"Watkins","year":"2017","journal-title":"N. Engl. J. Med."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"1155","DOI":"10.1161\/01.CIR.72.6.1155","article-title":"The virtual disappearance of rheumatic fever in the United States: Lessons in the rise and fall of disease. T. Duckett Jones memorial lecture","volume":"72","author":"Gordis","year":"1985","journal-title":"Circulation"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"199","DOI":"10.1016\/0021-9681(82)90140-0","article-title":"The Chicago rheumatic fever program: A 20 plus year history","volume":"35","author":"Levinson","year":"1982","journal-title":"J. Chronic Dis."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"441","DOI":"10.1086\/499812","article-title":"Temporal changes in streptococcal M protein types and the near-disappearance of acute rheumatic fever in the United States","volume":"42","author":"Shulman","year":"2006","journal-title":"Clin. Infect. Dis."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"81","DOI":"10.1016\/j.jacc.2022.09.050","article-title":"Rheumatic Heart Disease: JACC Focus Seminar 2\/4","volume":"81","author":"Dougherty","year":"2023","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"102740","DOI":"10.1016\/j.autrev.2020.102740","article-title":"Rheumatic heart disease: A review of the current status of global research activity","volume":"20","author":"Dooley","year":"2021","journal-title":"Autoimmun. Rev."},{"key":"ref_14","unstructured":"(2025). Global Burden of Cardiovascular Diseases and Risks 2023 Collaborators. Global, Regional, and National Burden of Cardiovascular Diseases and Risk Factors in 204 Countries and Territories, 1990\u20132023. J. Am. Coll. Cardiol., 86, 2167\u20132243."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"3","DOI":"10.1016\/j.echo.2022.10.009","article-title":"Recommendations for the Use of Echocardiography in the Evaluation of Rheumatic Heart Disease: A Report from the American Society of Echocardiography","volume":"36","author":"Pandian","year":"2023","journal-title":"J. Am. Soc. Echocardiogr."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"1541","DOI":"10.1161\/CIRCULATIONAHA.109.191959","article-title":"Prevention of rheumatic fever and diagnosis and treatment of acute Streptococcal pharyngitis: A scientific statement from the American Heart Association Rheumatic Fever, Endocarditis, and Kawasaki Disease Committee of the Council on Cardiovascular Disease in the Young, the Interdisciplinary Council on Functional Genomics and Translational Biology, and the Interdisciplinary Council on Quality of Care and Outcomes Research: Endorsed by the American Academy of Pediatrics","volume":"119","author":"Gerber","year":"2009","journal-title":"Circulation"},{"key":"ref_17","first-page":"CD015779","article-title":"Long-term antibiotic prophylaxis for prevention of rheumatic fever recurrence and progression to rheumatic heart disease","volume":"9","author":"Bray","year":"2024","journal-title":"Cochrane Database Syst. Rev."},{"key":"ref_18","doi-asserted-by":"crossref","unstructured":"Kotit, S., and Yacoub, M. (2026). The \u201cCairo Accord\u201d-towards the eradication of RHD: Revisited (2026). Front. Cardiovasc. Med., 13.","DOI":"10.3389\/fcvm.2026.1799972"},{"key":"ref_19","doi-asserted-by":"crossref","unstructured":"Herold, G. (2020). Innere Medizin, Self-Published.","DOI":"10.1515\/9783110688481"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"e25","DOI":"10.1016\/j.jacc.2020.11.018","article-title":"2020 ACC\/AHA Guideline for the Management of Patients With Valvular Heart Disease: A Report of the American College of Cardiology\/American Heart Association Joint Committee on Clinical Practice Guidelines","volume":"77","author":"Otto","year":"2021","journal-title":"J. Am. Coll. Cardiol."}],"container-title":["Infectious Disease Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2036-7449\/18\/4\/79\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,27]],"date-time":"2026-07-27T16:38:18Z","timestamp":1785170298000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2036-7449\/18\/4\/79"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7,27]]},"references-count":20,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2026,8]]}},"alternative-id":["idr18040079"],"URL":"https:\/\/doi.org\/10.3390\/idr18040079","relation":{},"ISSN":["2036-7449"],"issn-type":[{"value":"2036-7449","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7,27]]}}}