Rheumatic fever is an inflammatory disease that can develop as a complication of inadequately treated strep throat. Strep throat is caused by infection with group A streptococcus bacteria.
Rheumatic fever is most common in 5- to 15-year-old children, though it can develop in younger children and adults. Although it's very rare in United States and other developed countries, rheumatic fever remains common in many developing nations.
Rheumatic fever can cause permanent damage to the heart, including damaged heart valves and heart failure. Treatments can reduce tissue damage from inflammation, lessen pain and other symptoms, and prevent the recurrence of rheumatic fever.
Rheumatic fever symptoms may vary. Some people may have several symptoms, while others experience only a few. The symptoms may also change during the course of the disease. The onset of rheumatic fever usually occurs about two to four weeks after a strep throat infection.
Rheumatic fever signs and symptoms — which result from inflammation in the heart, joints, skin or central nervous system — may include:
When to see a doctor
Call your doctor about a fever in the following situations:
Also, see your doctor if your child shows any other signs or symptoms of rheumatic fever.
Rheumatic fever can occur after an infection of the throat with a bacterium called Streptococcus pyogenes, or group A streptococcus. Group A streptococcus infections of the throat cause strep throat or, less commonly, scarlet fever. Group A streptococcus infections of the skin or other parts of the body rarely trigger rheumatic fever.
The exact link between strep infection and rheumatic fever isn't clear, but it appears that the bacterium "plays tricks" on the immune system. The strep bacterium contains a protein similar to one found in certain tissues of the body. Therefore, immune system cells that would normally target the bacterium may treat the body's own tissues as if they were infectious agents — particularly tissues of the heart, joints, skin and central nervous system. This immune system reaction results in inflammation.
If your child receives prompt and complete treatment with an antibiotic to eliminate strep bacteria — in other words, taking all doses of the medication as prescribed — there's little to no chance of developing rheumatic fever. If your child has one or more episodes of strep throat or scarlet fever that aren't treated or not treated completely, he or she may — but won't necessarily — develop rheumatic fever.
Factors that may increase the risk of rheumatic fever include:
Inflammation caused by rheumatic fever may last for a few weeks to several months. In some cases, the inflammation may cause long-term complications.
Rheumatic heart disease is permanent damage to the heart caused by the inflammation of rheumatic fever. Problems are most common with the valve between the two left chambers of the heart (mitral valve), but the other valves may be affected. The damage may result in one of the following conditions:
Damage to the mitral valve, other heart valves or other heart tissues can cause problems with the heart later in life. Resulting conditions may include:
Preparing for your appointment
If your child has signs or symptoms of rheumatic fever, you're likely to start by seeing your family doctor or a specialist in children's medicine (pediatrician). However, your doctor may refer you to a heart specialist (pediatric cardiologist) for some diagnostic tests. Because appointments can be brief, it's a good idea to prepare for your appointment.
What you can do
List questions for your doctor from most important to least important in case time runs out. If you think your child is showing signs or symptoms of rheumatic fever, you may ask some of the following questions.
In addition to the questions that you've prepared to ask your doctor, don't hesitate to ask questions during your appointment at any time you don't understand something.
What to expect from your doctor
Tests and diagnosis
Your doctor makes a diagnosis of rheumatic fever based on:
Tests for strep infection
Treatments and drugs
The goals of treatment for rheumatic fever are to destroy any remaining group A streptococcal bacteria, relieve symptoms, control inflammation and prevent recurring episodes of rheumatic fever.
Treatments used for rheumatic fever include:
Long term care
Lifestyle and home remedies
Your doctor may recommend bed rest for your child and may ask you to restrict his or her activities until inflammation, pain and other symptoms have improved. If inflammation is present in heart tissues, your doctor may recommend strict bed rest for a few weeks to a few months, depending on the degree of inflammation.
The only known way to prevent rheumatic fever is to treat strep throat infections or scarlet fever promptly with a full course of appropriate antibiotics.
Last Updated: 2011-01-21
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