Rheumatic Fever

A serious but uncommon disease in which an infection involving bacteria known as Group A beta hemolytic streptococcus provokes an exaggerated response by the immune system, which in turn attacks the heart, joints, and other tissues.

Rheumatic fever is more common in winter spring. In general, children between the ages of five and15 are most susceptible to it. This disease has become uncommon in recent decades, probably because fewer streptococcal infections go untreated. Across North America rheumatic fever occurs in fewer than one in10,000 people each year.

Rheumatic fever involves many systems and tissues distinguishing it from other conditions can be difficult. The American Heart Association has developed criteria that help determine if an illness is in fact rheumatic fever. Usually finding two of the following symptoms (or one of the following along with other evidence) is necessary to make this diagnosis:

  • Heart disease. Rheumatic heart disease, the most serious component of rheumatic fever, occurs in one-half to two-thirds of all cases. The most significant problem is damage to one or more heart valves, although the heart muscle is frequently affected (myocarditis), as is the fibrous covering of the heart (pericarditis).
  • Arthritis. Pain, swelling, redness, and tenderness occur in multiple joints, either simultaneously or in a migratory fashion (literally appearing to move around to different parts of the body). Arthritis results in limitation of motion of joints and the inability to support weight.
  • Rash. Called erythema marginatum, this characteristic rash has an elevated, reddened margin. It typically appears only in severe cases of rheumatic fever.
  • Sydenham’s chorea. This neurological disturbance (once called St. Vitus’ Dance) is characterized by involuntary facial grimacing, clumsiness, abnormal movements of the extremities, and irritability.
  • Lumps under the skin. These nodules, which are not tender to the touch, occur on the arms, legs, or skull, usually only in severe cases.

Other findings that support the diagnosis of rheumatic fever include a persistent fever above101.4°F, joint pain without signs of inflammation or swelling, an abnormal electrocardiogram, or the history of a previous episode of rheumatic fever. In about 80 percent of cases there will be clinical and/or lab evidence of a recent streptococcal infection. All the signs of rheumatic fever, including arthritic chorea, and skin rash, will eventually disappear, but effects of damage to one or more heart valves may last a lifetime. Severely affected valves, which do not close properly during the heart’s normal cycle of contracting and then refilling with blood, may cause congestive seas failure, a condition in which a child’s heart cannot keep up with the demands of exertion or even quiet activities. In such cases, valve replacement may be necessary. Children who develop rheumatic fever must be treated with antibiotics to prevent any future streptococcal infection and regular doses of aspirin for two to in weeks to reduce arthritis and fever. (This is one of the few instances where aspirin is used to treat a child with an acute illness involving fever.) Rarely, cortisone is used in cases with severe heart involvement. Additional medications will be required to control heart failure, if it occurs.

An antigen (substance that can produce an immune response) present on the surface of red blood is in some individuals. When present, the person is found to be Rh-positive. Rh status is routinely determined when blood is donated and will be appropriately itched (along with blood type) to that of the recipient the past, differences in Rh status between mother and be by led to significant jaundice in some newborns