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Rheumatic Fever: Causes, Symptoms, Diagnosis, Treatments, Risk factors, Prevention, Complications

Rheumatic Fever: Causes, Symptoms, Diagnosis, Treatments, Risk factors, Prevention, Complications

What is Rheumatic Fever?

Rheumatic fever is one of the complications of inadequately treated strep throat. It is a serious illness that is usually seen in children between the ages of 5 and 15. Although, older children and adults may contract the illness as well.

It’s still common in places such as sub-Saharan Africa, south central Asia, and among certain populations in Australia and New Zealand. It’s rare in the United States.

Causes of Rheumatic Fever

Rheumatic fever is caused by a bacterium called group A Streptococcus. This bacterium causes strep throat or, in a small percentage of people, scarlet fever. It’s an inflammatory disorder.

Rheumatic fever causes the body to attack its own tissues. This reaction causes widespread inflammation throughout the body, which is the basis for all symptoms of rheumatic fever.

Symptoms of Rheumatic Fever

Rheumatic fever is caused by a reaction to the bacterium that causes strep throat. Although not all cases of strep throat result in rheumatic fever, this serious complication may be prevented with a doctor’s diagnosis and treatment of strep throat.

If your or your child have a sore throat along with any of the following symptoms, see your doctor for an evaluation:

  • tender and swollen lymph nodes
  • red rash
  • difficulty swallowing
  • thick, bloody discharge from nose
  • temperature of 101°F (38.3°C) or above
  • tonsils that are red and swollen
  • tonsils with white patches or pus
  • small, red spots on the roof of the mouth
  • headache
  • nausea
  • vomiting

A wide variety of symptoms are associated with rheumatic fever. A person with the illness could experience a few, some, or most of the following symptoms. Symptoms usually appear two to four weeks after your child has a strep infection.

Common symptoms of rheumatic fever include:

  • small, painless nodules under the skin
  • chest pain
  • rapid fluttering or pounding chest palpitations
  • lethargy or fatigue
  • nosebleeds
  • stomach pain
  • painful or sore joints in the wrists, elbows, knees, and ankles
  • pain in one joint that moves to another joint
  • red, hot, swollen joints
  • shortness of breath
  • fever
  • sweating
  • vomiting
  • a flat, slightly raised, ragged rash
  • jerky, uncontrollable movements of the hands, feet, and face
  • a decrease in attention span
  • outbursts of crying or inappropriate laughter

If your child has a fever, they might require immediate care. Seek immediate medical care for your child in the following situations:

  • For newborns to 6-week-old infants: more than a 100°F (37.8°C) temperature
  • For babies 6 weeks to 6 months old: a 101°F (38.3°C) or higher temperature
  • For a child of any age: a fever that lasts more than three days

Diagnosis of Rheumatic Fever

Your child’s doctor will first want to get a list of your child’s symptoms and their medical history. They’ll also want to know if your child has had a recent bout of strep throat. Next, a physical exam will be given. Your child’s doctor will do the following, among other things:

  • Look for a rash or skin nodules.
  • Listen to their heart to check for abnormalities.
  • Perform movement tests to determine their nervous system dysfunction.
  • Examine their joints for inflammation.
  • Test their throat and sometimes blood for evidence of strep bacteria.
  • Perform an electrocardiogram (ECG or EKG), which measures the electric waves of their heart.
  • Perform an echocardiogram, which uses sound waves to produce images of their heart.

Treatment of Rheumatic Fever

Treatment will involve getting rid of all of the residual group A strep bacteria and treating and controlling the symptoms. This can include any of the following:


Your child’s doctor will prescribe antibiotics and might prescribe a long-term treatment to prevent it from occurring again. In rare cases, your child may receive lifelong antibiotic treatment.

Anti-Inflammatory Treatment

Anti-inflammatory treatments include pain medications that are also anti-inflammatory, such as aspirin (Bayer) or naproxen (Aleve, Naprosyn). Though aspirin use in children with certain illnesses has been associated with Reye’s Syndrome, the benefits of using it in treating rheumatic fever may outweigh the risks. Doctors may also prescribe a corticosteroid to reduce inflammation.

Anticonvulsant Medications

Your child’s doctor might prescribe an anticonvulsant if involuntary movements become too severe.

Bed Rest

Your child’s doctor will also recommend bed rest and restricted activities until the major symptoms — such as pain and inflammation — have passed. Strict bed rest will be recommended for a few weeks to a few months if the fever has caused heart problems.

Risk Factors for Rheumatic Fever

Factors that increase your child’s chances of developing rheumatic fever include:

  • Family history. Certain genes make you more likely to develop rheumatic fever.
  • Type of strep bacteria present. Certain strains are more likely than others to lead to rheumatic fever.
  • Environmental factors present in developing countries, such as overcrowding.

Prevention of Rheumatic Fever

The most effective way to make sure your child doesn’t develop rheumatic fever is to start treating their strep throat infection within several days and to treat it thoroughly. This means ensuring your child completes all prescribed doses of medication.

Practicing proper hygiene methods can help prevent strep throat:

  • Cover your mouth when coughing or sneezing.
  • Wash your hands.
  • Avoid contact with people who are sick.
  • Avoid sharing personal items with people who are sick.

Complications of Rheumatic Fever

Once they develop, the symptoms of rheumatic fever can last for months or even years. Rheumatic fever can cause long-term complications in certain situations. One of the most prevalent complications is rheumatic heart disease. Other heart conditions include:

  • Aortic valve stenosis. This is a narrowing of the aortic valve in the heart.
  • Aortic regurgitation. This is a leak in the aortic valve that causes blood to flow in the wrong direction.
  • Heart muscle damage. This is inflammation that can weaken the heart muscle and decrease the heart’s ability to pump blood effectively.
  • Atrial fibrillation. This is an irregular heartbeat in the upper chambers of the heart.
  • Heart failure. This occurs when the heart can no longer pump blood to all parts of the body.

If left untreated, rheumatic fever can lead to:

  • stroke
  • permanent damage to your heart
  • death

What’s the outlook for people with rheumatic fever?

The long-term effects of rheumatic fever can be disabling if your child has a severe case. Some of the damage caused by the illness might not show up until years later. Be aware of long-term effects as your child grows older.

If your child does experience long-term damage related to rheumatic fever, there are support services available to help them and your family.

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