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Rheumatic fever or
RF; also see
Adult RF
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- Rheumatic Fever is an
inflammation condition that may follow an infectious episode
of the group A Streptococcus (a bacterium) -- 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).
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- Joint swelling and tenderness
- May involve many joints
- 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
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- 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.
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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.
- 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 blood) 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 the diseased
valves.
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- Children between ages of 5 -15
- Crowded places like schools, work
- Untreated strep throat
- Rheumatic Fever
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- 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 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 and other
major procedures.
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Contact
your physician as soon as you can. If there is high fever,
chorea, chest pain, fainting, or shortness of breath,
contact 911.
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