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Rheumatic fever
Symptoms & causes
Diagnosis & treatment
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Overview
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 (strep-toe-KOK-us) bacteria.
Rheumatic fever most often affects children who are between 5 and 15 years old,
though it can develop in younger children and adults. Although strep throat is common,
rheumatic fever is rare in the United States and other developed countries. However,
rheumatic fever remains common in many developing nations.
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Rheumatic fever can cause permanent damage to the heart, including damaged heart
valves and heart failure. Treatments can reduce damage from inflammation, lessen pain
and other symptoms, and prevent the recurrence of rheumatic fever.
Rheumatic fever symptoms vary. You can have few symptoms or several, and
symptoms can change during the course of the disease. The onset of rheumatic fever
usually occurs about two to four weeks after a strep throat infection.
Rheumatic fever signs and symptoms — which result from inflammation in the heart,
joints, skin or central nervous system — can include:
Fever
Painful and tender joints — most often in the knees, ankles, elbows and wrists
Chest pain
Heart murmur
Fatigue
Jerky, uncontrollable body movements (Sydenham chorea) — most often in the hands,
feet and face
Have your child see a doctor for signs or symptoms of strep throat, which include:
Fever
Headache
Proper treatment of strep throat can prevent rheumatic fever. Also, have your child see
a doctor if he or she shows other indications of rheumatic fever.
Causes
Rheumatic fever can occur after a throat infection from a bacteria called group A
streptococcus. Group A streptococcus infections of the throat cause strep throat or, less
commonly, scarlet fever.
Group A streptococcus infections of the skin or other parts of the body rarely trigger
rheumatic fever.
The link between strep infection and rheumatic fever isn't clear, but it appears that the
bacteria trick the immune system.
The strep bacteria contain a protein similar to one found in certain tissues of the body.
The body's immune system, which normally targets infection-causing bacteria, attacks
its own tissue, particularly tissues of the heart, joints, skin and central nervous system.
This immune system reaction results in swelling of the tissues (inflammation).
If your child receives prompt treatment with an antibiotic to eliminate strep bacteria and
takes all medication as prescribed, there's little chance of developing rheumatic fever.
If your child has one or more episodes of strep throat or scarlet fever that aren't treated
or aren't treated completely, he or she might develop rheumatic fever.
Risk factors
Family history. Some people carry a gene or genes that might make them more likely to
develop rheumatic fever.
Type of strep bacteria. Certain strains of strep bacteria are more likely to contribute to
rheumatic fever than are other strains.
Complications
Inflammation caused by rheumatic fever can last a few weeks to several months. In
some cases, the inflammation causes long-term complications.
Rheumatic fever can cause permanent damage to the heart (rheumatic heart disease).
It usually occurs 10 to 20 years after the original illness, but severe cases of rheumatic
fever can cause damage to the heart valves while your child still has symptoms.
Problems are most common with the valve between the two left chambers of the heart
(mitral valve), but the other valves can be affected.
Leak in the valve. A leaky valve causes blood to flow in the wrong direction.
Damage to heart muscle. The inflammation associated with rheumatic fever can weaken
the heart muscle, affecting its ability to pump.
Damage to the mitral valve, other heart valves or other heart tissues can cause
problems with the heart later in life. Resulting conditions can include:
Heart failure
Prevention
The only way to prevent rheumatic fever is to treat strep throat infections or scarlet fever
promptly with a full course of appropriate antibiotics.
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