- Rheumatic Fever
is an inflammation that may follow an infectious episode of the group 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
- Skin rash (erythema marginatum) and
nodules (painless, hard swellings under the skin and
- 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.
- 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
History of symptoms, illnesses, recent
infections, allergies, surgeries, habits
- Medical exam:
- 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.
- Throat (swabbed sample of the
throat) cultures may reveal the bacteria early in the
- Blood tests -- C-reactive protein
and ESR indicate ongoing inflammation. ASO (antistreptolysin O) and DNase
indicate infection with group A streptococcus.
- Anemias (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 show the
- Children between ages of 5 -15
- Crowded places like schools, work
- Untreated strepthroat
- Rheumatic Fever
- 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 be
corrected with medications.
- Steroids, such as Prednisone, are
used if there is a severe form of carditis (heart
- 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
- The patient with a damaged heart
valve may need to take antibiotics before dental and other
your physician as soon as you can. If there is high fever,
chorea, chest pain, fainting, or shortness of breath,
- Viral myocarditis
- Kawasaki's syndrome
- Lyme disease
- Infectious arthritis
- Endocarditis or murmurs from other causes
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