Rheumatic fever

Rheumatic fever

Rheumatic fever is an inflammatory disease that can develop when strep throat or scarlet fever isn't properly treated. Strep throat and scarlet fever are caused by an infection with streptococcus bacteria.

Rheumatic fever most often affects children ages 5 to 15. But it can develop in younger children and adults. 

Rheumatic fever can cause permanent damage to the heart, including damaged heart valves and heart failure. Treatment can ease pain, reduce damage from inflammation and prevent a recurrence of rheumatic fever.

Cause 

Rheumatic fever is an overreaction of your body’s immune system that causes it to fight healthy tissues. An untreated strep throat or scarlet fever infection can trigger this overreaction. It happens when group A streptococcus infections are not adequately treated with antibiotics.

When your body’s defenses (antibodies) begin to fight back, the reaction can damage healthy tissues and organs instead of the bacteria.

Signs and Symptoms 

Symptoms of strep throat include:

• sore throat
• headache
• swollen, tender lymph nodes
• trouble swallowing
• nausea and vomiting
• red skin rash
• high temperature
• swollen tonsils
• abdominal pain

Signs and symptoms generally develop 2 to 4 weeks after a streptococcal infection. Some individuals will experience just one or two of the following symptoms, but others may experience most of them:

• fatigue
• rapid heart rate
• decreased ability to exercise
• joint pain and swelling
• fever
• splotchy rash
• uncontrollable twitching and movements

Arthritis, or pain and swelling in the joints, affects 75 percent of patients. It normally starts in the larger joints, such as the knees, ankles, wrists, and elbows, before moving to other joints. This inflammation normally resolves within 4-6 weeks, without causing permanent damage.

Inflammation of the heart can lead to chest pain, palpitations, a sensation that the heart is fluttering or pounding hard, panting, and shortness of breath, and fatigue.

On average, around 50 percent of patients develop carditis or valvulitis, a potentially fatal inflammation of the heart that can have serious, long-term effects. Younger children are more susceptible.

Inflammation of the nerves can lead to symptoms of Sydenham’s chorea, including:

• chorea, the uncontrollable jerking of knees, elbows, wrists, and ankles
• inappropriate crying or laughing
• irritability and moodiness
• difficulty controlling fine hand movements
• problems with balance

Symptoms usually pass within a few months but can last up to 2 years. They are not normally permanent.

Other symptoms include a red, blotchy, skin rash, which appears in 1 in 10 cases. Less common are nosebleeds, abdominal pain, bumps and lumps, or nodules, under the skin, and a high fever over 102 degrees Fahrenheit.

The inflammation may also lead to headache, sweating, vomiting, and weight loss.

Diagnosis 

There is no single test used to diagnose rheumatic fever. Instead, doctors can look for signs of illness, check the patient’s medical history, and use many tests, including:

• A throat swab to look for a group A strep infection
• A blood test to look for antibodies to see if the patient recently had a group A strep infection
• Electrocardiogram or EKG (a test of how well the heart is working)
• Echocardiography or echo (a test that creates a movie of the heart muscle working)

Note: Rate under the appropriate body system any residual disability of infection, which includes, but is not limited to, heart damage