Rheumatic Fever


What is rheumatic fever?
Rheumatic fever is a delayed consequence of an untreated upper respiratory infection with group A streptococci (streptococcal pharyngitis or "strep throat"). The disease can cause serious, debilitating damage to the heart and involve other tissues.


Who gets rheumatic fever?
A small percentage, probably less than 0.3 percent, of all people who have streptococcal pharyngitis will develop acute rheumatic fever.

What are the symptoms of rheumatic fever?
Initially, rheumatic fever is acute. The major symptoms of rheumatic fever are: carditis, polyarthritis, chorea, subcutaneous nodules, and a rash called erythema marginatum.

Carditis is the most significant manifestation of rheumatic fever because it may cause permanent organ damage or death. Carditis is frequently mild or asymptomatic and therefore difficult to detect. Although not fully understood, a person's immune system response to a streptococcal infection appears to cause tissue degeneration, most frequently heart valve tissue, and subsequently, cardiac disability or death.

Polyarthritis is arthritis in a number of joints at a time. Chorea is a neurologic syndrome that may appear after a latent period of several months. Chorea is seen as rapid, purposeless, involuntary movements in the extremities and the face. Subcutaneous nodules are firm, painless lesions that occur over bony surfaces just under the skin. Erythema marginatum is a rash that appears mostly on the trunk and extremities.

How soon after exposure do symptoms appear?
The peak age of incidence for rheumatic fever is 5 to 15 years, but cases do occur in adults. Acute rheumatic fever is rare in children less than 4 years of age.

There is a latent period of 1 to 5 weeks (average 19 days) between streptococcal pharyngitis and the initial episode of acute rheumatic fever. The average duration of an attack of acute rheumatic fever is 3 months or longer. After the acute attack has subsided, many people are left with damaged heart valves (rheumatic heart disease). Some people will have recurrent acute attacks of rheumatic fever, frequently causing more damage to the heart valves.

How is it diagnosed?
May be difficult to diagnose. There are no specific laboratory tests to diagnose acute rheumatic fever. In general, rheumatic fever can be diagnosed with documentation of a recent infection with group A streptococcal infection and observation of one or more of the major symptoms (described above).

What is the treatment for rheumatic fever?
Antibiotics will not modify an acute rheumatic fever attack nor affect the subsequent development of carditis. However, a recommended regimen of antibiotics prescribed for treatment of streptococcal pharyngitis is recommended to eradicate any group A streptococci remaining in the patient, and in part, to prevent spread of the organism to close contacts.

What precautions should the person take who has had rheumatic fever?
Those people who have already suffered a rheumatic fever attack are extremely susceptible to a recurrence if they are again infected with group A streptococci. Patients who have experienced a documented acute rheumatic fever attack should receive continuous antibiotic prophylaxis to prevent streptococcal infections at least until reaching adulthood or at least 5 years after their most recent attack. Patients whose acute rheumatic fever attack has left them with damaged heart tissue may need lifelong antibiotic prophylaxis. Invasive dental or surgical procedures may require additional antibiotic prophylaxis for patients with rheumatic valvular heart disease.

How can rheumatic fever be prevented?
Prevention of rheumatic fever involves prompt, accurate diagnosis and effective treatment of streptococcal pharyngitis especially in school-aged children and others who live in crowded conditions such as the military and large households

** Note **

Please remember that the information presented in this forum is for your education only, and is not intended to extend medical advice or diagnosis. If you have questions or feel that you may be experiencing symptoms similar to those presented, please call the Berkeley County Health Department at (304) 263-5131 or your primary care provider for formal medical attention.