Rheumatic Fever

Definition

Rheumatic fever is an inflammatory condition involving connective tissue in the body. It's most severe complication is rheumatic heart disease. This condition may permanently damage the heart valves and affect the flow of blood to and from the heart. Symptoms of valve damage often don't appear for 10 to 30 years after the initial episode of rheumatic fever.

Diseased Heart Valve

Diseased Aortic Valve

© 2008 Nucleus Medical Art, Inc.

Causes

Rheumatic fever is a complication of group A Streptococcus pharyngitis ( strep throat ). The vast majority of people with strep throat do not develop rheumatic fever. However, in some people infected with group A strep, the body's immune system not only fights the bacteria, but also attacks its own tissue, especially heart tissue.

Risk Factors

A risk factor is something that increases your chance of getting a disease or condition.

Risk factors include:

  • Age: 5 to 15 years old
  • Previous case of rheumatic fever
  • Malnutrition
  • Overcrowded living conditions

Symptoms

Symptoms usually appear 2 to 4 weeks after a strep infection. They may include:

  • Pain and swelling in large joints
  • Fever
  • Weakness
  • Muscle aches
  • Shortness of breath
  • Chest pain
  • Nausea and vomiting
  • Hacking cough
  • Circular rash
  • Lumps under the skin
  • Abnormal, sudden movements of arms and legs

Diagnosis

The doctor will ask about your symptoms and medical history, and perform a physical exam. This will include a careful exam of your heart. The doctor may take a throat culture and perform a blood test for streptococcal antibodies.

Other tests may include:

  • Other blood tests—such as erythrocyte sedimentation rate to measure inflammation in the body, and blood cultures to determine if bacteria is present in the blood
  • Electrocardiogram—a test that records the heart's activity by measuring electrical currents through the heart muscle
  • Echocardiogram—a sonogram which visualizes the heart valves, and measures the contractile function of the heart muscle
  • Chest x-rays—a test that uses radiation to take a picture of structures inside the body, in this case the heart

Treatment

The goals of treatment are to:

  • Kill the strep bacteria
  • Treat the inflammation caused by the rheumatic fever
  • Prevent future cases of rheumatic fever

Treatment may include:

Antibiotics

Penicillin or other antibiotics including erythromycin and azithromycin may be given to treat the strep infection. People who have had rheumatic fever are at high risk of getting it again. To prevent another bout of rheumatic fever, you may need to take antibiotics regularly for several years after the initial infection. These may be given by mouth or by monthly injections.

Anti-inflammatory Drugs

Aspirin or other nonsteroidal anti-inflammatory drugs (NSAIDs) may help with joint pain and swelling. Corticosteroids may be used if NSAIDs are not effective.

Rest

If inflammation is severe, the doctor may prescribe bed rest or severe restriction of physical activity for a period of time.

Prevention

Promptly treating strep throat with antibiotics can prevent rheumatic fever. If you or your child has a sore throat and a fever that lasts more than 24 hours, contact your doctor.

RESOURCES:

American Heart Association
http://www.americanheart.org

National Library of Medicine
http://www.nlm.nih.gov/

CANADIAN RESOURCES:

Health Canada
http://www.hc-sc.gc.ca/index_e.html

Heart and Stroke Foundation of Canada
http://ww2.heartandstroke.ca

References:

American Heart Association website. Available at: http://www.americanheart.org .

Mayo Clinic and Foundation for Medical Education and Research website. Available at: http://www.mayo.edu/ .

The Merck Manual of Medical Information—Home Edition . Merck Research Laboratories; 1999.

Nausieda PA, Grossman BJ, Koller WC: Sydenham chorea: an update. Neurology . 1980;30:331-334.

Robertson KA, Volmink JA, Mayosi BM. Antibiotics for the primary prevention of acute rheumatic fever. BMC Cardiovasc Disorders . 2005; 5:11.

Spagnuolo M, Pasternack B, Taranta A. Risk of rheumatic fever recurrences after streptococcal infections: prospective study of clinical and social factors. N Engl J Med . 1971;285:641-647.

University of Michigan Medical Center website. Available at: http://www.med.umich.edu/ .



Last reviewed February 2008 by Jill Landis, MD

Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.


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