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.
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.
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.
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/
.
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.
