Rheumatic fever is a delayed immune response that can occur after infections with certain group A streptococcal bacteria. It causes damage to certain organs, particularly the heart.
Strep throat and scarlet fever are two types of infections that precede rheumatic fever. If a person is not treated effectively with antibiotics for these infections, he or she may have an immune response. The effects of this response can be seen in the heart, joints, brain, and skin.
The most serious effect of rheumatic fever is a heart valve defect known as mitral stenosis. Rheumatic fever was more common before antibiotics were available to treat infections.
Rheumatic fever may begin suddenly with joint pain and fever about 2 to 6 weeks after a streptococcal infection. This form of the disease is most common in older people. Rheumatic fever may also develop slowly, starting with a mild infection of the heart. This form of the disease is more common in children.
Symptoms of rheumatic fever vary, but may include the following: abdominal distressconfusioncoughfatiguefeverjoint pain and swellingmuscle painnosebleedsrashesskin nodulesspeech impairmentsunusual jerky movementsvomitingweakness
Rheumatic fever is an immune response to an infection with group A streptococcus. The same bacteria cause strep throat and scarlet fever. While streptococcal skin infections are relatively common, they have not been linked to rheumatic fever.
Rheumatic fever is most prevalent in school-age children who are 5 to 15 years old. It is seen most often in the cold winter months when strep throat is also most common. Rheumatic fever may also occur in adults. It is seen with equal frequency in men and women. However, women with rheumatic fever are more likely to develop Sydenham chorea and mitral stenosis.
Effective treatment of strep infections with antibiotics significantly lowers a person's risk of developing rheumatic fever. Individuals with these infections should take their full course of antibiotics, even after symptoms are gone.
Diagnosis of rheumatic fever starts with a medical history and physical examination. The healthcare professional may also order diagnostic tests. These may include the following: a throat culturean antibody titeran echocardiogram, or ultrasound of the hearta chest X-ray
The American Heart Association has issued guidelines for the diagnosis of rheumatic fever. Known as the Jones criteria, these guidelines include lab test findings as well as signs and symptoms of the disease.
In 75% of people with rheumatic fever, the acute attack lasts only 6 weeks. Ninety percent of the cases of rheumatic fever resolve in 12 weeks or less, and more than 95% in six months or less.
The many possible complications of rheumatic fever include: anemia, which is a low red blood cell countarrhythmias, which are abnormal heart rhythmsarthritisbacterial pericarditis, an inflammation of the sac surrounding the heartcongestive heart failure, a condition in which the weakened heart is unable to pump blood effectively throughout the bodyendocarditis, which is an inflammation of the lining of the heartheart valve damage, including mitral stenosis and mitral valve prolapseproteinuria, a condition in which protein is lost in the urineskin disordersSydenham chorea, a nervous system disorder that causes involuntary, writhing movements
Rheumatic fever itself is not contagious and poses no risk to others. However, the streptococcal infection can be highly contagious.
A person with strep throat will be given antibiotics such as penicillin and erythromycin. Nonsteroidal anti-inflammatory drugs (NSAIDs) such as aspirin and ibuprofen, may be used as needed for pain and fever. However, aspirin should not be used by children because of the risk for developing a serious neurologic condition called Reye syndrome.
A person who has rheumatic fever will be given antibiotics as well as NSAIDs. Corticosteroids, such as prednisone, may be used to modify the immune response. Bed rest is recommended for a person who has rheumatic fever. Some healthcare professionals prescribe digoxin (i.e., Lanoxin), a medicine that strengthens the contractions of the heart.
After the initial treatment, a slow increase in physical activity is allowed. Any complications are treated on a case-by-case basis.
Antibiotics and pain medicines may cause stomach upset, rash, and allergic reactions. Corticosteroids can increase the person's risk of infection.
A person who has had rheumatic fever may need lifelong treatment with antibiotics to prevent further attacks. He or she may also be advised to take preventive antibiotics before surgery or dental procedures.
The healthcare professional will monitor a person for the complications of rheumatic fever, sometimes with repeated echocardiograms and other tests. Any new or worsening symptoms should be reported to the professional.