Description

Rheumatic fever is an inflammatory disease that can develop when the strep throat or scarlet fever is not treated properly. Inflammation of the throat and scarlet fever are caused by an infection with streptococcus bacteria of the foot-KOK-us) of the bacteria.

Rheumatic fever most often affects children ages 5 to 15. But young children and the adults can do it too. Rheumatic fever is rare in the united States and other developed countries.

Rheumatic fever can cause long-lasting damage to the heart, including heart valve problems and heart failure. The treatment includes medicines to kill the strep bacteria. Other medicines are used to treat pain and prevent complications.

Symptoms

Rheumatic fever symptoms usually begin around 2 to 4 weeks after a strep throat infection. The symptoms are due to swelling, called inflammation, in the heart, joints, skin or the central nervous system. There may be few symptoms or more. The symptoms may come and go or change, while the person is ill with rheumatic fever.

Rheumatic fever symptoms may include:

  • Fever.
  • Joint pain or swelling of the majority of the time, the knees, ankles, elbows and wrists. Joints may feel warm or tender.
  • Pain in a joint traveling to another set.
  • Pain in the chest.
  • Fatigue.
  • Small painless bumps under the skin.
  • Flat or slightly elevated, without pain, rashes on the skin with an uneven edge.

Some people with rheumatic fever develop a condition called sydenham's chorea. The symptoms of this condition include:

  • Beef jerky, uncontrollable movements of the body, most often on the hands, feet, and face.
  • Outbursts of crying or inappropriate laughing.

When to see a doctor

Correctly treating strep throat can prevent rheumatic fever. Make an appointment with a health care professional if any of these symptoms of strep throat are produced:

  • A sore throat that comes on suddenly.
  • Pain when swallowing.
  • Fever.
  • The pain of a headache.
  • Stomach pain, nausea, and vomiting.

Causes

Rheumatic fever may occur following an infection of the throat of the group a streptococcus bacteria is also called strep bacteria. The bacteria that causes strep throat and scarlet fever. Improperly treated, inflammation of the throat or scarlet fever, infections cause rheumatic fever.

There is little chance of rheumatic fever when strep throat is treated promptly with antibiotics. It is important to finish all of the medicine.

The group a streptococcus infections of the skin or other parts of the body rarely cause rheumatic fever.

How to a strep infection, the cause of rheumatic fever is not clear. It may be that the bacteria to trick the body's immune system to attack healthy tissues. This usually happens in the heart, joints, skin and the central nervous system. The incorrect reaction of the immune system that causes swelling of the joints and tissues. This inflammation is called inflammation.

Risk factors

Things that may increase the risk of rheumatic fever include:

  • Genes. Some people have one or more genes that may make them more likely to develop rheumatic fever.
  • Specific type of strep bacteria. Some strains of strep bacteria are more likely to cause fever rheumatic other.
  • The environmental factors. Overcrowding, lack of sanitation and other conditions can cause streptococcal bacteria are spread among many people. These conditions increase the risk of rheumatic fever.

Complications

Joint and tissue swelling caused by rheumatic fever can last for a couple of weeks to several months. For some people, the swelling of the causes of long-term complications.

A complication of rheumatic fever is long-lasting damage to the heart. This is called rheumatic heart disease. Rheumatic heart disease usually occurs years to decades after the original disease.

However, severe rheumatic fever may start to damage the heart valves, while a child still has symptoms of the infection. The valve between the two left chambers of the heart is the most commonly affected. This valve is called the mitral valve. But other valves of the heart can also be affected.

Rheumatic fever can cause these types of damage in the heart:

  • The narrowing of a heart valve, also called valve stenosis. The valve flaps become thick or stiff, and, possibly, to connect together. This decreases the flow of blood through the valve.
  • Retrograde flow of the blood through a heart valve. This is called valve regurgitation. Occurs when the valve flap is not closed properly.
  • The damage to the heart muscle. Swelling in the tissue of rheumatic fever can weaken the heart muscle. This damage can affect the heart's ability to pump.
  • Heart failure. Heart damage from rheumatic fever can also cause heart failure later in life.
  • Irregular heart beats. Damage to the valves of the heart or other areas of the heart can lead to irregular and very rapid heartbeats. This is also known as atrial fibrillation (AFib).

Prevention

The best way to prevent rheumatic fever is for the treatment of strep throat infections or scarlet fever immediately. It is also important to finish all of the prescribed antibiotics as directed.

Diagnosis

There is No single test for rheumatic fever. The diagnosis of rheumatic fever is based on the clinical history, a physical exam and certain test results.

Tests

Tests for rheumatic fever are:

  • Blood tests.Blood tests may be done to check if there are signs of inflammation in the body. These tests include the C-reactive protein (CRP) and the erythrocyte sedimentation rate (ESR), also called the rate of sedimentation. Sometimes the streptococcus bacteria are no longer present in the blood or in the tissues of the throat. Another blood test can be done to search for proteins related to the strep bacteria. These proteins are called antibodies.
  • Electrocardiogram (ECG or EKG). This test shows how the heart is beating. You can help to diagnose irregular heart beats. A health care professional can check the ECG signal patterns for signs of cardiac inflammation.
  • The echocardiogram. Use sound waves to create images of the heart in motion. An echocardiogram shows the structure of the heart and how blood flows through it.

Blood tests. Blood tests may be done to check if there are signs of inflammation in the body. These tests include the C-reactive protein (CRP) and the erythrocyte sedimentation rate (ESR), also called the rate of sedimentation.

Sometimes the streptococcus bacteria are no longer present in the blood or in the tissues of the throat. Another blood test can be done to search for proteins related to the strep bacteria. These proteins are called antibodies.

Treatment

The goals of treatment for rheumatic fever are:

  • The treatment of the infection.
  • Relieve the symptoms.
  • Control the inflammation, called inflammation.
  • Prevent the condition from returning.

Medications

Rheumatic fever is treated with medications, including:

  • Antibiotics.Penicillin or other antibiotic is usually given to kill the strep bacteria. After the first antibiotic treatment is completed, another round of antibiotics may be administered. This stops the rheumatic fever that comes back. A child may need to continue taking antibiotics for 5 years or until 21 years of age to prevent rheumatic fever is back, whichever is the greater. The people who had inflammation of the heart in rheumatic fever, you may need to continue antibiotics for 10 years or more.
  • Anti-inflammatory medications. Aspirin or naproxen (Naprosyn, Naprelan, Anaprox DS) can help reduce inflammation, pain and fever. If the symptoms are severe or do not improve with anti-inflammatory medications, a corticosteroid may be prescribed. Do not give a child aspirin unless a healthcare professional tells you to do so.
  • Anti-seizure drugs. Medications such as valproic acid or carbamazepine (Carbatrol, Tegretol, others) can be used to treat severe cases of involuntary movements caused by sydenham's chorea.

Antibiotics. Penicillin or other antibiotic is usually given to kill the strep bacteria.

After the first antibiotic treatment is completed, another round of antibiotics may be administered. This stops the rheumatic fever that comes back. A child may need to continue taking antibiotics for 5 years or until 21 years of age to prevent rheumatic fever is back, whichever is the greater.

The people who had inflammation of the heart in rheumatic fever, you may need to continue antibiotics for 10 years or more.

It is important to have regular health exams after rheumatic fever. Heart damage from rheumatic fever may not appear until after many years, even decades. Always tell your health care provider about any history of rheumatic fever.

Lifestyle and home remedies

A health care provider may recommend bed rest for someone with rheumatic fever. There may be restrictions on the activity until your symptoms improve.

Preparing for your appointment

Make an appointment for a health checkup if the symptoms of rheumatic fever develop. If there is damage to the heart, you may be sent to a physician skilled in diseases of the heart, called a cardiologist.

Here's some information to help you prepare for the appointment.

What you can do

When you make the appointment, ask if any special preparations are necessary. For example, you may not be able to eat or drink for a time before some blood tests. Make a list of:

  • The symptoms, including any that seem unrelated to the reason for the appointment.
  • Important personal information, including major stresses, recent life changes and family medical history.
  • All the medications, vitamins, or other supplements being taken. Include the dose.
  • Questions to ask the health care team.

For rheumatic fever, basic questions to ask the care team include:

  • What are the possible causes of the symptoms?
  • What tests are needed?
  • What treatment is needed?
  • What are the options for the main treatment you are suggesting?
  • I or my child have other health conditions. How can we best manage them together?
  • There is activity or dietary restrictions?
  • We need to see a specialist?
  • Are there brochures or other printed material I can have? What sites do you recommend?

Do not hesitate to ask other questions.

What to expect from your doctor

The health team is likely to ask questions, such as:

  • When did the symptoms begin?
  • What, if anything, seems to improve your symptoms?
  • What, if anything, appears to worsen your symptoms?
  • The symptoms occur all the time or come and go?
  • Have someone in your family has been sick with a cold or the flu lately?
  • There is a history of strep throat or scarlet fever?
  • If so, they were all prescribed antibiotics?
Symptoms and treatment of Rheumatic fever