Rheumatic Fever

Rheumatic fever is a complication of untreated strep throat. It is an inflammation which affects the entire body. Rheumatic fever is most common in children between the ages of 5 and 15. However, it can develop in adults. It may run in families and may be associated with overcrowding. Rheumatic fever can damage the heart and affect the joints, central nervous system, skin, and underlying tissues. Most cases of strep throat do not lead to rheumatic fever when properly treated. Even without treatment, only a few cases will develop rheumatic fever.

CAUSES

Rheumatic fever can occur after a throat infection of the bacterium Streptococcus pyogenes, or group A streptococcus. In rheumatic fever, immune system cells that would normally target the bacterium may attack the body's own tissues, especially tissues of the heart, joints, skin, and central nervous system.

SYMPTOMS

Problems commonly show up within a few weeks after a strep throat infection. Symptoms vary and can include:

  • Fever.

  • Chest pain.

  • Abdominal pain.

  • Shortness of breath.

  • Painless bumps under the skin.

  • Heart irregularities.

  • Rash.

  • Joint pain that moves around. The pain is usually in the elbows, wrists, ankles, and knees.

  • Swelling, warmth, and redness of the joints.

  • Rapid, uncoordinated, jerky movements of the facial muscles, hands, and feet (chorea).

Severe problems of rheumatic fever involve the heart. These problems come from the permanent damage done to the heart valves. The most common problems involve inflammation of the heart (endocarditis), mitral valve narrowing (mitral stenosis), and aortic valve narrowing (aortic stenosis). Narrowed valves make it harder for the heart to pump blood. This may lead to heart failure and an irregular heartbeat. A patient may also have a leaky valve. This allows blood to flow in the wrong direction (regurgitation).

DIAGNOSIS

Your caregiver may suspect the diagnosis based on an exam after a recent sore throat or upper respiratory infection.

  • Blood tests may be done to confirm the diagnosis when there is evidence of a previous strep infection.

  • Electrocardiography (EKG) records the electrical activity of the heart. This indicates inflammation of the heart or poor heart function.

  • Echocardiography bounces sound waves off your chest. This shows damaged structures of the heart.

TREATMENT

There is no cure. The goals of treatment are to destroy any remaining bacteria, relieve symptoms, control inflammation, and prevent recurring episodes.

  • Medicines that kill germs (antibiotics), such as penicillin, are prescribed to eliminate any remaining bacteria. After that treatment, another course of antibiotics are prescribed to prevent rheumatic fever from coming back. This preventive treatment typically continues until the age of 20. It may continue in an older patient until he or she has taken the antibiotics for a minimum of 5 years or as directed.

  • Anti-inflammatory pain relievers, such as aspirin or naproxen, may be prescribed to reduce inflammation, fever, and pain. If symptoms are severe, your caregiver may prescribe a corticosteroid, such as prednisone.

  • Anticonvulsant medicines may be prescribed if involuntary movements of chorea are severe.

HOME CARE INSTRUCTIONS

  • Gargle with warm salt water 3 to 4 times per day, or as instructed, for comfort.

  • Family members with a sore throat or fever should have a medical exam or throat culture. If there has been a positive throat culture in the family, your caregiver may treat the entire family.

  • You may return to work when you feel able.

  • Only take over-the-counter or prescription medicines for pain, discomfort, or fever as directed by your caregiver.

SEEK MEDICAL CARE IF:

  • You or your child has an oral temperature above 102° F (38.9° C).

  • Large glands develop in the neck.

  • You have a sore throat without cold symptoms.

  • You develop a rash, cough, or earache.

  • You have difficulty swallowing anything, including saliva.

  • You cough up green, yellow-brown, or bloody sputum.

  • You have pain or discomfort not controlled by medicines.

SEEK IMMEDIATE MEDICAL CARE IF:

  • New symptoms develop. This may include vomiting, severe headache, a stiff or painful neck, chest pain, shortness of breath, or trouble breathing or swallowing.

  • You or your child develops severe throat pain, drooling, or changes in the voice.