Rheumatic fever

1. Overview

Rheumatic fever is an inflammatory disease that can develop when strep throat or scarlet fever isn't properly treated. 

Strep throat and scarlet fever are caused by an infection with streptococcus bacteria.

Rheumatic fever most often affects children who are between 5 and 15 years old.

Rheumatic fever occurs commonly in many developing nations.

The onset of rheumatic fever usually occurs about two to four weeks after a strep throat infection.

Rheumatic fever can cause permanent damage to the heart (rheumatic heart disease).Problems are most common with the mitral valve, but the other valves can be affected

2. Signs and Symptoms of rheumatic fever

Fever

Painful and tender joints — most often in the knees, ankles, elbows and wrists

Pain in joint that migrates to another joint(migratory polyarthritis)

Red, hot or swollen joints

Small, painless bumps beneath the skin(subcutaneous nodules)

Chest pain

Heart murmur

Non itchy Painless rash(erythema marginatum)

Jerky, uncontrollable body movements (Sydenham chorea) — most often in the hands, feet and face

Outbursts of unusual behavior, such as crying or inappropriate laughing, that accompanies Sydenham chorea

Proper treatment of strep throat can prevent rheumatic fever.

3. Causes

Rheumatic fever can occur after a throat infection from a bacteria called 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 rarely trigger rheumatic fever.

Cross reacting antibodies

If your child receives prompt treatment with an antibiotic to eliminate strep bacteria and takes all medication as prescribed, there's little chance of developing rheumatic fever.

If your child has one or more episodes of strep throat or scarlet fever that aren't treated or aren't treated completely, he or she might develop rheumatic fever.

4. Risk Factors

Factors that can increase the risk of rheumatic fever include:

Family history

Type of strep bacteria. Certain strains of strep bacteria are more likely to contribute to rheumatic fever than are other strains.

5. Complications

Rheumatic fever can cause permanent damage to the heart (rheumatic heart disease). It usually occurs 10 to 20 years after the original illness

Problems are most common with the valve between the two left chambers of the heart (mitral valve), but the other valves can be affected.

6. Prevention

The only way to prevent rheumatic fever is to treat strep throat infections or scarlet fever promptly with a full course of appropriate antibiotics.

7. Diagnosis 

Diagnosis is based on medical history, a physical exam and certain test results. Tests might include -

a) Blood tests - Inflammatory markers are checked in blood, which include C-reactive protein and the erythrocyte sedimentation rate.

Sometimes, a blood test that can detect antibodies to the strep bacteria in the blood is done.

b) ECG

c) Echocardiogram

8. Treatment

a) Antibiotics

Penicillin is given to eliminate remaining strep bacteria

After completing the full antibiotic treatment, another course of antibiotics is started to prevent recurrence of rheumatic fever

Preventive treatment will likely continue upto age 21 or until a minimum five-year course of treatment is completed whichever is longer

People who have had heart inflammation during rheumatic fever might be advised to continue preventive antibiotic treatment for 10 years or longer

b) Anti inflammatory treatment 

Aspirin or naproxen - to reduce inflammation, fever and pain

c) Anticonvulsant medications

For severe involuntary movements caused by Sydenham chorea, antiseizure medications, such as valproic acid or carbamazepine is used