Rheumatic fever is an inflammatory condition that can arise from untreated strep throat or scarlet fever. An infection with the streptococcus (strep-toe-KOK-us) bacteria causes strep throat and scarlet fever. Rheumatic fever most commonly affects children aged 5 to 15, while it can also affect younger children and adults. Despite the prevalence of strep throat, rheumatic fever is uncommon in the United States and other industrialized countries. Rheumatic fever, on the other hand, is still prevalent in many underdeveloped countries. Rheumatic fever can harm the heart permanently, resulting in damaged heart valves and heart failure. Inflammation-related damage can be reduced with treatment. 

Symptoms 

Symptoms of rheumatic fever differ. Symptoms might be few or numerous, and they can change over time as the condition progresses. After a strep throat infection, rheumatic fever commonly appears two to four weeks later. 

The following are some of the indications and symptoms of rheumatic fever, which are caused by inflammation in the heart, joints, skin, or central nervous system: 

• Fever 
• Joints that are painful and tender, most commonly in the knees, ankles, elbows, and wrists 
• Pain that spreads from one joint to another 
• Joints that are red, heated, or swollen 
• Underneath the skin, there are little, harmless lumps. 
• Pain in the chest 
• a murmur in the heart 
• Fatigue 
• Painless rash with a ragged margin that is flat or slightly elevated. 
• Jerky, uncontrollable movements — most commonly in the hands, feet, and face (Sydenham chorea) 
• Sydenham chorea is characterized by outbursts of odd behavior, such as crying or inappropriate laughing. 

When should you see a doctor?  

Consult a doctor if your child exhibits any of the following signs or symptoms of strep throat: 

• A quick onset of a sore throat 
• Suffering from swallowing pain 
• Fever 
• Headache 
• Pain in the stomach, nausea, and vomiting 

Rheumatic fever can be avoided with proper strep throat treatment. If your child exhibits other symptoms of rheumatic fever, take him or her to the doctor. 

Causes 

Rheumatic fever can develop following a throat infection caused by group A streptococcus bacteria. Strep throat or, less commonly, scarlet fever are caused by Group A streptococcus infections of the throat. Rheumatic fever is infrequently caused by Group A streptococcus infections of the skin or other regions of the body. The cause of strep infection and rheumatic fever is unknown, although the germs appear to deceive the immune system. The strep bacteria carry a protein that is similar to one found in the body's tissues. The body's immune system, which is designed to fight infection-causing microorganisms, instead destroys healthy tissue such as the heart, joints, skin, and central nervous system. 

The tissues enlarge as a result of the immune system's reaction (inflammation). There's a slim risk your child may develop a rheumatic fever if he or she receives quick antibiotic treatment to remove strep bacteria and takes all medications as directed. Your child may get rheumatic fever if he or she has one or more bouts of strep throat or scarlet fever that aren't treated or aren't treated entirely. 

Factors that are at risk 

Rheumatic fever can be triggered by several factors, including:  

History of the family. Some persons have a gene or genes that increase their chances of getting a rheumatic fever. 

Streptococcus mutans is a kind of strep bacterium. Certain strep bacterium strains are more prone to cause problems. 

Environmental considerations are important. Overcrowding, poor sanitation, and other factors that might easily result in rapid transmission or multiple exposures to strep germs are linked to a higher risk of rheumatic fever. 

Complications 

Rheumatic fever inflammation can continue anywhere from a few weeks to several months. Inflammation can lead to long-term consequences in some people. The heart might be permanently damaged by rheumatic fever (rheumatic heart disease). Although it normally happens 10 to 20 years after the first infection, severe episodes of rheumatic fever might damage your child's heart valves while he or she is still experiencing symptoms. The valve connecting the two left chambers is the most commonly affected. 

The following are some of the consequences of the damage: 

• The valve is narrowing. Blood flow is reduced as a result of this. 
• The valve leaks. Blood flows in the wrong direction due to a leaking valve. 
• Heart muscle damage. Rheumatic fever's inflammation can damage the heart muscle, reducing its ability to pump blood. 
• Damage to the mitral valve, other heart valves, or heart tissues might result in heart difficulties later in life. The following are some of the possible outcomes:  
• A heartbeat that is erratic and chaotic (atrial fibrillation) 
• Insufficiency of the heart

Diagnosis  

Rheumatic fever is diagnosed based on medical history, a physical exam, and certain test results, even though there is no single test for it. 

Blood tests 

Your doctor may not order additional tests for the bacterium if your child has previously been diagnosed with strep throat using a throat swab test. A blood test to detect antibodies to the strep bacteria in the blood is sometimes performed. In your child's throat tissues or blood, the bacteria may no longer be recognizable. To screen for rheumatic fever, your doctor will likely measure inflammatory markers in your child's blood, such as C-reactive protein and the erythrocyte sedimentation rate.

An EKG is a type of electrocardiogram (ECG or EKG) This test captures electrical signals as they pass through the heart of your child. The results can reveal if your heart's electrical activity is abnormal, and they can also help your doctor figure out if any portions of your heart are enlarged. 

Echocardiogram: Sound waves are utilized to create live-action images of the heart, which can aid in the detection of cardiac issues by your doctor. 

Treatment 

The purpose of rheumatic fever treatment is to eliminate the remaining group of bacteria. A streptococcal bacteria can help to ease symptoms, reduce inflammation, and avoid recurrence. 

The following are some of the treatments: 

Antibiotics. To eradicate the infection, your child's doctor will prescribe penicillin or another antibiotic. 

Your doctor will start another course of antibiotics after your child has finished the full antibiotic therapy to avoid rheumatic fever recurrence. Preventive treatment will most likely last until your child reaches the age of 21 or until he or she has completed a minimum five-year course of treatment, whichever comes first. 

 People who have heart inflammation during rheumatic fever may be advised to take antibiotics for 10 years or longer as a prophylactic measure. 

Treatment for inflammation. To minimize inflammation, fever, and pain, your doctor will prescribe a pain reliever such as aspirin or naproxen (Naprosyn, Naprelan, Anaprox DS). If your child's symptoms are severe or the anti-influenza medication isn't working, 

Anticonvulsant drugs are used to treat seizures. Antiseizure drugs, such as valproic acid (Depakene) or carbamazepine, may be prescribed for severe involuntary movements caused by Sydenham chorea (Carbatrol, Tegretol, others).  

Long-term assistance 

Talk to your doctor about how much follow-up and long-term care your child will require. 

Rheumatic fever can cause heart damage that takes years to manifest. Your child will need to record the information in his or her medical history and have frequent heart checkups as he or she grows older.