Rheumatic Fever

1 What is Rheumatic Fever?

An inflammatory disease that can develop as a complication of inadequately treated strep throat or scarlet fever is called Rheumatic fever.

Rheumatic fever is most common in children between the age of 5 and 15 years old, though it can also develop in younger children and adults. 

The two main causes of Rheumatic fever are strep throat and scarlet fever are infections from a group A streptococcus bacteria.

Strep throat infection is more common in the US, as rheumatic fever mostly common in developing nations and is rare in the United States and other developed countries.

Rheumatic fever can cause permanent damage to the heart, including damaged heart valves leading to hear failure. Hence, treatment is focused on reducing tissue damage from inflammation, lessen pain and other symptoms, as well as the prevention of the recurrence of rheumatic fever.

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2 Symptoms

The onset of rheumatic fever usually occurs about two to four weeks after a strep throat infection and symptoms may vary. Some people may present with several symptoms while others may only experience a few.

Signs and symptoms of Rheumatic fever may result from inflammation in the heart, joints, skin or central nervous system, hence might manifest as follows: 

  • fever
  • painful and tender joints
  • most often the ankles
  • knees
  • elbows or wrists
  • less often the shoulders
  • hips
  • hands and feet

Other signs and symptoms include:

  • pain in one joint that migrates to another joint
  • small
  • painless nodules beneath the skin
  • red
  • hot or swollen joints
  • flat or slightly raised
  • painless rash with a ragged edge (erythema marginatum)
  • chest pain
  • heart murmur
  • fatigue
  • jerky
  • uncontrollable body movements (Sydenham chorea or St. Vitus' dance) which is most often in the hands
  • feet and face

Symptoms may also include behavioral changes such as:

  • outbursts of unusual behavior
  • such as crying or inappropriate laughing
  • that accompanies Sydenham chorea

Be aware of the signs and symptoms of Strep throat and if your child already present such symptoms then it is time to consult a doctor, as treatment of strep throat can prevent the complication of rheumatic fever.

Familiarize yourself with the following signs and symptoms as manifestations of any of these should alarm to bring your child to a doctor for immediate medical attention. A sore throat without cold symptoms, such as:

  • A runny nose.
  • Difficulty swallowing anything, including saliva.
  • A bright red tongue with bumps all over it, known as strawberry tongue.
  • A sore throat accompanied by tender, swollen lymph glands (nodes).

A red rash that starts at the head and neck, then expands to the trunk and extremities. Thick or bloody discharge from the nose, which is more likely in children under 3 years of age. Presence of fever is also created hence you would need to contact your child’s doctor in the follow scenarios: Newborns up to 3 months old with a fever of 100.4 F (38 C) taken rectally.

Children ages 3 to 6 months with a temperature of 102 F (38.9 C) or higher. Children ages 6 months to 2 years with a fever of 102 F (38.9 C) or higher that doesn't respond to medication or lasts more than one day. Children ages 2 to 17 years with a fever of 102 F (38.9 C) or higher (taken rectally for children younger than 3 and orally for children older than 3) that doesn't respond to medication or lasts more than three days.

Educate yourself as well with the signs and symptoms of rheumatic fever as immediate medical attention is needed when your shows any of its symptoms.

3 Causes

A strep throat infection is the main cause of the development of Rheumatic fever. A strep throat occurs after an infection of the throat with a bacterium called Streptococcus pyogenes, or group A streptococcus.

In less common cases, scarlet fever which is also an infection from a Group A streptococcus lead to rheumatic fever.

Group A streptococcus infections of the skin or other parts of the body rarely trigger rheumatic fever. The strep bacterium contains a protein similar to one found in certain tissues of the body.

Therefore, immune system cells that would normally target the bacterium may treat the body's own tissues as if they were infectious agents — particularly tissues of the heart, joints, skin and central nervous system. Although the exact link between strep infection and rheumatic fever isn't clear, but it appears that the bacterium "plays tricks" on the immune system.

This immune system reaction results in inflammation. If the child is able to complete all prescribed dosages of antibiotics to treat strep throat infection, then it will most likely that the child will not develop rheumatic fever.

On the other hand, if the child has had a recurrent strep throat infection of scarlet fever that has not been treated completed then it most likely to develop into rheumatic fever.

4 Making a Diagnosis

If your child has signs and symptoms of rheumatic fever, your doctor may most likely refer you to a heart specialist (pediatric cardiologist) for some diagnostic tests.

You must come prepared prior to your appointment to have a better understanding of Reye’s syndrome and the needed treatment.

Here are some things to prepare prior to the appointment start with having a list of important personal and medical information. Make a list of symptoms your child is experiencing or has recently experienced, even if the symptoms don't seem related to each other, include recent illnesses your child has had and medications, including vitamins or supplements, that your child takes or has recently taken.

Prepare questions to ask the doctor such as to better understand rheumatic fever, such as:

  • Does my child have rheumatic fever?
  • What other conditions could cause these symptoms?
  • What kinds of tests will my child need now and in the future?
  • What is the best treatment?
  • Will rheumatic fever or its treatment have any effect on my child's other health conditions?
  • How much do I need to restrict my child's activities?
  • Is my child still contagious? For how long?
  • What type of follow-up is needed?
  • Are there any brochures or other printed material that I can take home with me?
  • What websites do you recommend visiting?

Do not be afraid to ask your doctor follow-up questions especially if a topic is confusion to you. Before performing or ordering diagnostic tests, your doctor would first complete your child’s medical history by asking you questions such as:

  • When did your child's signs and symptoms first appear?
  • How have these signs and symptoms changed over time?
  • Has your child had a cold or flu recently?
  • What were the symptoms?
  • Has your child been exposed to a known case of strep throat?
  • Was your child recently diagnosed with strep throat or scarlet fever?
  • Did your child take all of the antibiotics to treat strep throat or scarlet fever as prescribed?

Your doctor will make a diagnosis of rheumatic fever based on signs and symptoms, physical exam and test results. During physical exam, your child's doctor will conduct a thorough physical examination that may include:

  • Checking the joints for signs of inflammation
  • checking for fever
  • examining the skin for nodules under the skin or a rash
  • and listening to the heart for abnormal rhythms
  • murmurs or muffled sounds that may indicate inflammation of the heart

Simple movement tests may also be conducted to determine evidence of inflammation of the central nervous system. If your child has had previous strep throat infection, your doctor will order a blood test that can detect antibodies to strep bacteria circulating in the blood since the actual bacteria may no longer be detected in your child’s throat, tissues or blood as presumably it has been treated.

Another diagnostic test that would have to be performed is an Electrocardiogram, also called an ECG or EKG, which records electrical signals as they travel through your child's heart.

Your doctor can look for patterns among these signals that indicate inflammation of the heart or poor heart function.

Echocardiography An echocardiogram uses sound waves to produce live-action images of the heart. This common test may enable your doctor to detect altered structures within the heart.

Damage to heart valves isn't likely to occur early in the disease, but an echocardiogram can show such problems. Even after rheumatic fever has been completely treated, periodic check-ups would still need to be done in the future to reassess the heart valves if damaged were made due to rheumatic fever.

5 Treatment

The goals of treatment for rheumatic fever include:

  • Destruction of any remaining group A streptococcal bacteria,
  • relieve symptoms,
  • control inflammation,
  • prevent recurring episodes.

Treatment used for rheumatic fever includes different drug combinations such as Anti-inflammatory medications, Antibiotics and Anticonvulsant medications. Anti-inflammatory treatment.

Your doctor will prescribe a pain reliever, such as aspirin or naproxen (Anaprox, Naprosyn, others), to reduce inflammation, fever and pain.

If symptoms are severe or your child isn't responding to the anti-inflammatory drugs, your doctor may prescribe a corticosteroid, such as prednisone.

Treatments used for rheumatic fever include a continuous antibiotic treatment to treat the current condition as well as prevent recurrent episodes.

Your child's doctor will prescribe penicillin or another antibiotic to eliminate any remaining strep bacteria that may exist in your child's body. After your child has completed the full antibiotic treatment, your doctor will begin another course of antibiotics to prevent recurrence of rheumatic fever.

This preventive treatment usually continues until your child is at least 21 years old. If an older teenager has had rheumatic fever, he or she may continue taking the antibiotics past age 20 to complete a minimum five-year course of preventive treatment.

People who experienced inflammation of the heart when they had rheumatic fever may be advised to take the preventive antibiotic treatment much longer or even for life.

Anticonvulsant medications. If the involuntary movements of Sydenham chorea are severe, your doctor may prescribe an anticonvulsant, such as valproic acid (Depakene) or carbamazepine (Carbatrol, Equetro, others).

Heart damage from rheumatic fever may not show up until many years after the acute illness. Your child should be informed that he or she had rheumatic fever and when an adult should discuss this with his or her doctor.

It is imperative for you to discuss with your doctor the needed long term care for your child.

6 Prevention

Prompt treatment of strep throat infections and scarlet fever with a full course of the necessary antibiotics is the only known way to prevent development of rheumatic fever.

7 Alternative and Homeopathic Remedies

Some of the homeopathic remedies for rheumatic fever include:

  • Belladonna,
  • Bryonia,
  • Causticum,
  • Iodum,
  • Lycopodium,
  • Rhus Tox,
  • Aconite,
  • Calcarea Carb,
  • Chamomilla,
  • Colocynth,
  • Dulcamara,
  • Mercurius,
  • Natrum Muriaticum,
  • Phosphorus,
  • Pulsatilla,
  • Sulphur,
  • Sepia.

These homeopathic remedies are to be taken with professional advice.

8 Lifestyle and Coping

Lifestyle modifications are necessary in order to cope with rheumatic fever.

Your doctor may recommend restriction in activity as well as bed rest for your child until inflammation, pain and other symptoms have improved.

If inflammation is present in heart tissues, your doctor may recommend strict bed rest for a few weeks to a few months, depending on the degree of inflammation to this prevent further aggravation of the symptoms leading to further pain and discomfort.

9 Risks and Complications

There are several factors that increase the risk of rheumatic fever and it is as follows:

  • Type of strep bacteria. Certain strains of strep bacteria are more likely to contribute to rheumatic fever than are other strains.
  • Environmental factors. A greater risk of rheumatic fever is associated with overcrowding, poor sanitation and other conditions that may easily result in the rapid transmission or multiple exposures to strep bacteria.
  • Family history. Some people may carry a gene or genes that make them more likely to develop rheumatic fever.
  • Inflammation caused by rheumatic fever may last for a few weeks to several months and may lead to long-term complications.
  • Damage to heart muscle. The inflammation associated with rheumatic fever can weaken the heart muscle, resulting in poor pumping function.
  • Damage to the mitral valve, other heart valves or other heart tissues can cause problems with the heart later in life.

Resulting conditions may include:

  • Atrial fibrillation.
  • An irregular and chaotic beating of the upper chambers of the heart (atria) Heart failure.
  • An inability of the heart to pump enough blood to the body.

Rheumatic heart disease is permanent damage to the heart caused by the inflammation of rheumatic fever. Problems are most common with the valve between the two left chambers of the heart (mitral valve), but the other valves may be affected.

The damage may result in one of the following conditions:

  • Valve stenosis. This condition is a narrowing of the valve, which results in decreased blood flow.
  • Valve regurgitation. This condition is a leak in the valve, which allows blood to flow in the wrong direction.