Rheumatic fever is an inflammation that may follow an infectious episode with group A beta hemolytic Streptococcus bacteria -- usually of the throat. In RF there may be heart (carditis) and multiple joint (polyarthritis) damage. RF also may affect the skin (rash, nodules) and the nervous system (e.g., abnormal involuntary movements).
Joint swelling and tenderness
May involve many joints
May involve the heart: irregular heart beat, shortness of breath, chest pain
Fever
Skin rash (erythema marginatum) and nodules (painless, hard swellings under the skin and overlying bones)
Nose bleeds (epistaxis)
Symptoms of RF often occur within 7-35 days after infection.
In some, symptoms of RF may last 3 months or longer.
Vomiting
Abdominal pain
Sydenham's chorea -- jerky, involuntary, purposeless movements (of legs and arms), muscle weakness, speech problems, and emotional instability
Throat infection with the group A Streptococcus (pharyngitis, Scarlet Fever) may start an autoimmune reaction in which the body's defenses, in the process of attacking the bacteria (using proteins known as antibodies), may damage or cause inflammation -- swelling, irritation, and pain -- to certain body parts, such as the skin, heart valves, joints, and brain.
The autoimmune response leads to RF.
Children between ages of 5 -15
Crowded places like schools, work
Untreated strep throat in fall, winter, and early spring.
History of symptoms, illnesses, recent infections, allergies, surgeries, habits
Medical exam:
Fever
Rash or nodules
Swollen tender joints
Chorea may be present
Using a stethoscope, the doctor may hear an abnormal flow of blood (murmur) across a damaged heart valve (endocarditis).
If the sac that covers the heart is inflamed (pericarditis) there may be chest pain with each breath (pleuritic chest pain), shortness of breath, and a characteristic friction rub may be heard (with a stethoscope) over the chest.
Tests:
Throat (swabbed sample of the throat) cultures may reveal the bacteria early in the disease.
Blood tests -- C-reactive protein and ESR indicate ongoing inflammation. ASO (antistreptolysin O) and DNase indicate infection with group A streptococcus.
Anemia (low red blood cell count) may be present
Electrocardiogram -- measures the electrical activity of the heart -- may show changes indicating damage to the electrical pathways inside the heart (prolonged P-R interval).
Echocardiography -- using sound waves, may show fluid around the heart and may show the diseased valves.
Bed rest
Penicillin is the antibiotic of choice and is given to all patients except those with allergy to penicillin, who receive alternative drugs.
NSAIDs (such as aspirin) may reduce inflammation of the joints and relieve pain and fever.
Irregular heart rhythms can usually be corrected with medications.
Steroids, such as prednisone, are used if there is a severe form of carditis (heart inflammation).
Chorea can be treated with medications such as Haldol.
Patients often receive penicillin (monthly injections) until adulthood or up to 5 years after an attack of RF.
Some experts recommend treatment with antibiotics for life, especially if there is severe valve damage.
The patient with a damaged heart valve may need to take antibiotics before dental work and other procedures.
Contact your physician as soon as you can. If there is high fever, chorea, chest pain, fainting, or shortness of breath, contact 911.
