Rheumatic fever is an inflammatory disease that may develop as a complication of a streptococcus infection, such as strep throat or scarlet fever (caused by Streptococcus pyogenes or group A beta-hemolytic streptococcus). If it does develop, it will usually do so two to three weeks after the Group A streptococcal infection.
Rheumatic fever mainly affects children aged between 5 and 15 years; however, it can affect adults and younger children. Boys and girls have the same risk of developing the disease; girls and women tend to have more severe symptoms. The disease may cause long term effects on the skin, heart, brain and joints. Rheumatic fever may cause permanent damage to the heart valves (rheumatic heart disease). Rheumatic fever has the potential to cause heart failure, stroke and even death.
Even though there is no current cure for rheumatic fever, antibiotics, anti-inflammatory drugs and anticonvulsants may be used to relieve symptoms and prevent recurrences.
The disease is fairly rare in most developed nations, but is still common in many other parts of the world, particularly in sub-Saharan Africa, south central Asia, and the indigenous population of Australia and New Zealand. Before the widespread introduction of antibiotics and increased levels of public sanitation and living standards, rheumatic fever used to be one of the leading causes of acquired heart disease in developed nations.
The National Health Service (NHS), UK, estimates that approximately 1 in every 100,000 people is affected by rheumatic fever in England annually.
Patients aged between 25 and 35 years may have recurring episodes of rheumatic fever.
According to Medilexicon’s medical dictionary:
A symptom is something the patient feels and reports, while a sign is something other people, such as the doctor detect. For example, pain may be a symptom while a rash may be a sign.
According to The Mayo Clinic (USA), rheumatic fever signs and symptoms generally develop 2 to 4 weeks after a streptococcal throat infection (1 to 5 weeks according to the National Health Service, UK).
As you can see below, there are many possible signs and symptoms linked to rheumatic fever – a patient will not necessarily have them all:
A risk factor is something which increases the likelihood of developing a condition or disease. For example, obesity significantly raises the risk of developing diabetes type 2. Therefore, obesity is a risk factor for diabetes type 2.
Rheumatic fever may develop as a complication after a throat infection with Streptococcus pyogenes, or group A streptococcus (a bacterium). Strep throat, and less commonly scarlet fever are infections caused by Group A streptococcus infections. Group A streptococcus skin infections, as well as infections in other parts of the body may lead to rheumatic fever (much less common).
Although experts are not completely sure what the link between strep infection and rheumatic fever is, they believe that the bacterium upsets the patient’s immune system. Strep bacteria have a protein which is similar to one found in some tissues in our body. Immune system cells that would usually target the bacterium may subsequently start attacking the body’s own tissues, as if they were toxins or infectious agents; especially tissues of the heart, joints, CNS (central nervous system) and skin, resulting in inflammation.
Inflammation can cause the following symptoms:
If the patient who is infected with strep bacteria takes the complete antibiotic treatment, the chances of rheumatic fever developing are negligible (zero or tiny). However, if the patient has at least one episode of untreated strep throat or scarlet fever, his/her risk of developing rheumatic fever increases significantly.
According to the National Health Service (NHS), UK, there are so many different rheumatic fever symptoms that a checklist is needed to help in the diagnosis process – this checklist is called the Jones Criteria. The Jones Criteria involves checking whether the patient has specific signs and symptoms strongly linked to rheumatic fevers. These signs and symptoms are collectively known as criteria.
There are two types of criteria:
A confident rheumatic fever diagnosis can be made if:
Some of the signs and symptoms may be detected just by examining and interviewing the patient. Others will require testing. Testing may include:
The medical team’s aims are to destroy the bacteria, relieve symptoms, control inflammation and prevent recurrences of rheumatic fever.
Antibiotics – the patient, usually a child, will probably be prescribed penicillin or some other antibiotic to destroy any remaining strep bacteria in the body.
It is important to get rid any streptococcocal bacteria. If any is left inside the body and the patient has another throat infection, there is a serious risk of a recurrence of rheumatic fever. Repeated occurrences of rheumatic fever significantly raise the risk of heart damage (sometimes permanent).
Anti-inflammatory treatment – an anti-inflammatory drug, such as or naproxen (Anaprox, Naprosyn, etc.) may be prescribed. These medications reduce pain, inflammation and fever. A corticosteroid, such as prednisone may be prescribed if the patient does not respond to anti-inflammatory medications or there is inflammation of the heart.
Aspirin is not usually recommended for children aged less than 16 years because there is a risk of developing Reye’s syndrome, which can cause liver and brain damage, and even death. However, an exception is usually made when the child has rheumatic fever because the dose is small and the results are very good – in other words, the benefits are far greater than the risks.
Long term care – any child who had rheumatic fever will need to know later on that he/she once had rheumatic fever. As an adult the individual should discuss this with his/her doctor. Heart damage from rheumatic fever may not appear for many years after the illness.
Rheumatic fever symptoms, specifically inflammation, may persist for several weeks, months, and in some cases much longer, causing long-term problems.
Rheumatic heart disease – the most common and most serious complication. According to the National Health Service (NHS), UK, an estimated 9% to 34% of rheumatic fever cases have this complication. Rheumatic heart disease means permanent damage to the heart caused by the inflammation of rheumatic fever. The most common complication occurs with the mitral valve – the valve between the two left chambers of the heart. Sometimes other valves may also be affected. The following conditions may result:
These conditions may also develop if there is damage to heart tissue, and/or damage to the mitral valve or other heart valves: