Rheumatic Fever

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KEY POINTS

• Rheumatic fever is a disease that causes inflammation of many parts of the body and can damage the heart, joints, brain, and skin.
• Rheumatic fever is caused by a reaction to a strep throat infection, so treatment includes antibiotic medicine to kill the strep bacteria and other medicines.
• Help your child take all medicines as prescribed, and ask your child’s healthcare provider how to take care of your child at home.

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What is rheumatic fever?

Rheumatic fever is a disease that causes inflammation (swelling and redness) of many parts of the body. The disease can damage the heart, joints, brain, and skin.

What is the cause?

Rheumatic fever is caused by a reaction to a strep throat infection. Why some people have this reaction to strep bacteria is not well understood. Rheumatic fever may happen when your body’s defense against infection attacks the body as well as the strep germ. It can affect different parts of the body.

Most children with strep throat do not get rheumatic fever. Your child is more at risk for rheumatic fever if he or she has had:

• An untreated strep infection
• An incompletely treated infection because your child didn’t take all the medicine prescribed, or
• Several strep infections

Your child’s risk is also higher if other family members have had rheumatic fever.

What are the symptoms?

Symptoms, which usually start 2 to 3 weeks after a sore throat, may include:

• Aching and swollen joints (ankles, knees, elbows, wrists) with the pain and swelling often moving from joint to joint
• Fever
• Tiredness
• Chest pain
• Abdominal pain
• Shortness of breath
• Jerky, uncontrollable movements of the face, arms, and legs
• Red, flat, painless, and nonitching rash on the chest and belly or arms and legs
• Nose bleeds
• Small bumps under the skin on the elbows or knees

How is it diagnosed?

Your healthcare provider will ask about your child’s symptoms and medical history and examine your child. Tests may include:

• Blood tests
• A throat culture
• Chest X-ray
• An echocardiogram, which uses sound waves (ultrasound) to see how well the heart is pumping
• An ECG (also called an EKG or electrocardiogram), which measures and records the heartbeat

How is it treated?

The treatment may include:

• Antibiotic medicine to kill the strep bacteria
• Medicine to control fever, joint pain, and inflammation
• Steroid medicine to treat inflammation of the heart
• Medicine to help control jerky movements
• Bed rest until your child has a normal temperature without medicine
• Many weeks of decreased activity

Rheumatic fever can last from 6 weeks to more than 6 months. Your child’s long-term health depends on how the heart has been affected by the disease. Rheumatic fever can weaken the heart muscle and affect the heart's ability to pump. The heart valves may also be affected. One or more valves may become scarred and after a while may have trouble opening and closing properly. Damage to the valves may not show up until years after the illness. Eventually, the valve may need to be repaired or replaced with surgery. Starting antibiotic treatment early when your child has rheumatic fever may prevent permanent damage to the heart. Your child may also need medicines to treat any heart symptoms.

It’s very important to keep from getting rheumatic fever again. Repeated infections increase the chances of permanent heart damage. Your child may need to take medicine daily, or get monthly shots to keep from having a strep infection again.

How can I take care of my child?

• Make sure that your child takes all medicines as prescribed.
  • Make sure that your child takes the full course of antibiotics prescribed by your child’s healthcare provider. Your child may need to take an antibiotic regularly for months or years to prevent another strep infection. If your child has had certain heart problems, heart valve surgery, or a heart transplant, he or she may need to take antibiotics before dental treatments or any kind of surgery.
  • Using a steroid for a long time can have serious side effects. Steroid medicine needs to be taken exactly as your healthcare provider prescribes. Your child should not take more or less of it than prescribed by your provider and should not take it longer than prescribed. Your child should not stop taking a steroid without your provider's approval. Your child may have to lower the dosage slowly before stopping it.
• Make sure that your child drinks lots of liquids unless your child’s healthcare provider has told you to limit liquids
• Follow the full course of treatment prescribed by your child’s healthcare provider. Ask your provider:
  • How and when you will get your child’s test results
  • How long it will take your child to recover
  • If there are activities your child should avoid and when your child can return to normal activities
  • How to take care of your child at home
  • What symptoms or problems you should watch for and what to do if your child has them
• Make sure you know when your child should come back for a checkup.

How can I help prevent rheumatic fever?

Tell your child’s healthcare provider if your child has a:

• Sore throat and fever that last more than 24 hours
• Severe sore throat without cold symptoms
• A bright red tongue with bumps all over it
• Difficulty swallowing anything, even saliva
• Sore throat after being around someone with a strep throat
• A red rash that starts at the head and goes down to the body and limbs

The best way to prevent rheumatic fever is by getting quick treatment for strep throat and scarlet fever.