Acute rheumatic fever is characterized by non suppurative inflammatory lesions involving the heart, joints, subcutaneous tissues and central nervous system. It is a complication of group A streptococcal upper respiratory tract infection. The pathogenic mechanisms remain unknown although there is a general agreement as to an immunological hypothesis. Pharyngitis must be treated, even if streptococcal origin is not proved. Penicillin remains the first choice antibiotic. Epidemiological studies of all group A streptococcal serotypes isolated should be performed.