Rheumatic Fever

Rheumatic Fever Overview

Rheumatic fever and rheumatic heart disease are complications of infection from group A streptococcus, a bacterium that causes strep throat and scarlet fever. It is the most common bacterial infection of the throat. Rheumatic fever becomes rheumatic heart disease when the inflammation it causes leads to permanent damage to heart valves and tissue. Among the serious cardiac complications of rheumatic fever:

Valve stenosis, a narrowing of the valve resulting in decreased blood flow.
Valve regurgitation, a leak that allows blood to flow in the wrong direction.
Weakened heart muscle and a decrease in proper pumping function.
Atrial fibrillation, an irregular heartbeat (of the upper chambers).
Heart failure.

Rheumatic fever most commonly strikes children between the ages of 5 and 15 years, but it may also occur in people of other ages. It most often recurs in adults between 25 and 35 years of age. Rheumatic fever is relatively rare in the United States, although isolated outbreaks do occur, the most recent in the 1980s. The illness is common in developing countries, however.

Symptoms

People with rheumatic fever may show few or many symptoms, and their symptoms may change over time. These symptoms may begin to appear two to four weeks after the person contracts strep throat or scarlet fever, if those infections are not diagnosed and treated with a full course of antibiotics. Symptoms of rheumatic fever include:

Fever
Abdominal pain
Fatigue
Heart palpitations
Chest pain
Shortness of breath
Joints that are tender, painful, red or swollen (mainly the knees, ankles, elbows and wrists)
Painless rash with jagged edges (erythema marginatum); may look ring-shaped or snake-like
Small, painful nodules below the skin
Nosebleeds
Sydenham chorea or St. Vitus’ dance : jerky, uncontrollable body movements and muscle weakness, most often seen in the face, hands and feet
Unusual behavior, such as inappropriate crying or laughter (a symptom of Sydenham chorea)

Risk Factors

The best way to prevent rheumatic fever is to treat strep throat or scarlet fever with a full course of antibiotics. Risk factors for rheumatic fever include:

A family history of rheumatic fever
Exposure to particular strep strains—some strains contribute to rheumatic fever more than other strains.
Unsanitary environmental conditions—overcrowding and other conditions that allow for easy and mass transmission of the strep bacteria.

Rheumatic Fever Prevention

Rheumatic fever is a complication of strep throat and scarlet fever. The only way to prevent rheumatic fever is to be diagnosed with infection by the streptococcus bacterium and treated with a full course of antibiotics.

Reduce Your Risk of Rheumatic Fever

You can lower your chances of getting rheumatic fever by seeing your Wellstar physician when you have the following strep throat and scarlet fever symptoms and comply with your doctor’s treatment:

A sore throat that lasts longer than one week
Recurring sore throats
Difficulty swallowing
Difficulty breathing
Excessive drooling (young children)
A temperature above 100.3° F (in children under three months old)
A temperature above 102° F (in children six months or older), if the temperature continues to rise or lasts more than three days
Pus on the back of the throat
Hoarseness that lasts longer than two weeks
Blood in the saliva or phlegm
Symptoms of dehydration (dry, sticky mouth, sleepiness, thirst, decreased urination, few or no tears when crying, muscle weakness, headache, dizziness or lightheadedness)
Contact with someone diagnosed with strep throat
Sunburn-like red rash that feels like sandpaper (scarlet fever)
Flushed face with paleness around the mouth (scarlet fever)
Pastia’s lines: red lines in folds of skin around the groin, armpits, elbows, knees, neck (scarlet fever)
Red and bumpy tongue, with white coating early in illness (scarlet fever)
Fever of 101° F or higher, often with chills (scarlet fever)
Headache, nausea, vomiting (scarlet fever)

Tests and Screenings

Currently, there is no one test for rheumatic fever, but your Wellstar physician may use a combination of tests to diagnose rheumatic fever as well as its impact on the heart, joints and immune system. Among the tests:

Blood test to check for recurrent strep infection.
Complete blood count.
Examination of inflammation.
Electrocardiogram.
ESR (erythrocyte sedimentation rate), a nonspecific test used in conjunction with other diagnostic methods to determine whether disease is causing inflammation.

Rheumatic Fever Diagnosis

If screening tests or check-ups reveal abnormal results, your Wellstar pediatrician or other physician may perform further evaluations regarding rheumatic fever and related diseases. They may also refer you to a Wellstar cardiologist for special testing.

Rheumatic Fever Treatment

The most common treatments for acute rheumatic fever are antibiotics, anti-inflammatory medications and a longer-term antibiotic regimen to prevent a recurrence of the illness.

Taking Care of Rheumatic Fever

Your Wellstar physician may prescribe antibiotics to help rid your body of remaining streptococcus bacterium. He or she may also recommend bed rest.

To control inflammation, fever and pain, your doctor may recommend aspirin or naproxen (Anaprox^®, Naprosyn^®, among brand names). If you don’t respond to those medications, your doctor may prescribe a corticosteroid, such as prednisone.
To control involuntary movements of Sydenham chorea, your doctor may prescribe an anticonvulsant, such as valproic acid (Depakene^® or Stavzor^®, among brand names) or carbamazepine (Carbatrol^® and Equetro^®, among brand names).
It is common for physicians to prescribe a five-year course of low-dose antibiotics to prevent a recurrence of rheumatic fever. In some cases, a lifetime course of antibiotics is prescribed to prevent a recurrence and the possibility of further damage to the heart tissue.

In every case, your Wellstar physician will help you weigh the benefits of each treatment approach and make an experienced recommendation for the best outcome. You can feel confident your decision will be based on both your input and the expertise and recommendations of your experienced physician.

Ongoing Care for Rheumatic Fever

Wellstar’s world-class, community-based physicians utilize state-of-the-art medical centers and hospitals with the latest technologies and medical resources. Our clinicians are dedicated to:

Helping you create and maintain healthy lifestyles.
Offering advice to prevent illness and injuries.
Providing early and appropriate care of acute illness to prevent its progression.

Care at Home

Treatment for rheumatic fever can often improve symptoms and help you live longer. You and your Wellstar physician can work together to make your life more comfortable, so pay close attention to your body and your post-treatment regimen, and keep your doctor updated. As part of your post-treatment care and in addition to maintaining a healthy diet and exercise, you should:

Keep track of all medications you take.
Avoid certain over-the-counter medications, such as non-steroidal anti-inflammatory drugs (ibuprofen, naproxen and others), cold medications and diet pills.
Keep track of your weight and blood pressure.
Write down your questions and never be afraid to ask your Wellstar physicians for clarification.