What is Rheumatic Fever in Children

Rheumatic fever is a condition that can develop after an untreated strep throat infection. It causes inflammation that may affect the entire body.

Rheumatic fever most often affects the heart, joints, central nervous system, skin, and underlying tissues. In some cases, rheumatic fever can cause serious damage to the heart.

What are the causes?

This condition may be caused by an abnormal reaction of the body’s immune system to the bacteria that causes strep throat (group A streptococcus). The Streptococcus infection usually occurs in the throat, but it may occur in the skin or another part of the body. The exact cause of the reaction is not known.

What increases the risk?

This condition is more likely to develop in:

• Children who are 5–15 years old.
• Children who have a family history of the condition.
• Children who live in overcrowded or unsanitary conditions.

What are the signs or symptoms?

Symptoms of this condition usually develop within a few weeks after a strep throat infection. Symptoms vary, and they can include:

• Fever.
• Rash.
• Tiredness.
• Loss of appetite.
• Pain in the abdomen.
• Joint pain that moves around. The pain is usually in the elbows, wrists, ankles, and knees.
• Painless bumps under the skin.
• Swelling, warmth, and redness of the joints.
• Shortness of breath.
• Irregular heartbeat.
• Chest pain.
• Rapid, jerky movements of the facial muscles, hands, and feet (chorea).

In severe cases, this condition can cause heart problems. These problems may include:

• Inflammation of the heart (carditis).
• Narrowing of heart valves (mitral stenosis and aortic stenosis).
• Leaky heart valves that allow blood to flow in the wrong direction (mitral regurgitation).
• Congestive heart failure. This is a condition in which too much fluid causes the heart to pump poorly.
• Atrial fibrillation. This is a fast, irregular beating of the upper chambers of the heart.

How is this diagnosed?

This condition may be diagnosed based on a physical exam, your child’s medical history, and blood tests. Your child may also have other tests, including:

• Throat culture to find out what kind of bacteria your child has.
• Chest X-ray.
• Electrocardiogram (ECG) to check the electrical activity of the heart. This can indicate inflammation of the heart or poor heart function.
• Echocardiogram to check for damaged heart valves or damage to other parts of the heart.

If your child’s heart is affected, he or she will be referred to a heart specialist (cardiologist).

How is this treated?

Treatment for this condition focuses on relieving symptoms, reducing organ damage, and preventing rheumatic fever from occurring again. Treatment may include:

• Antibiotic medicines to get rid of any remaining bacteria. After that treatment, another course of antibiotics will be given to stop rheumatic fever from coming back. Your child will likely need to continue this preventive treatment for a number of years.
• Anti-inflammatory medicines to reduce inflammation, fever, and pain. If symptoms are severe, your child may be given a corticosteroid medicine, such as prednisone.
• Anticonvulsant medicines, if your child has severe symptoms of chorea.
• Medicines or surgery to manage carditis, damage to heart valves, or heart failure.

Follow these instructions at home:

Medicines

• Give over-the-counter and prescription medicines only as told by your child’s health care provider.
• If your child was prescribed an antibiotic medicine, give it to him or her as told by the health care provider. Do not stop giving the antibiotic even if he or she starts to feel better.
• Do not give your child aspirin because it has been associated with Reye’s syndrome.

General instructions

• Have your child rest. He or she should return to normal activities slowly as told by his or her health care provider.
• Have your child drink enough fluid to keep his or her urine pale yellow.
• If swallowing is difficult, give your child soft foods until his or her sore throat feels better.
• Make sure that any dentists or other health care providers who care for your child know that your child has had rheumatic fever.
• Keep all follow-up visits as told by your child’s health care provider. This is important.

How is this prevented?

• Most cases of rheumatic fever can be prevented with proper treatment of any strep throat infection. If your child has had rheumatic fever, taking antibiotic medicine as directed can help prevent the condition from coming back.
• Have family members who also have a sore throat or fever tested for strep throat. They may need antibiotics if they have the strep infection.
• Your child should not share food, drinking cups, or personal items. This can cause the infection to spread to other people.

Contact a health care provider if your child:

• Has a sore throat that does not get better.
• Has pain that is not relieved by medicine.
• Has a fever.
• Has swollen glands in the neck.
• Has difficulty swallowing.
• Develops a rash.
• Has nausea and vomiting.

Get help right away if your child:

• Is younger than 3 months and has a temperature of 100°F (38°C) or higher.
• Has a severe headache.
• Has a stiff or painful neck.
• Has joints that become red or painful.
• Has chest pain.
• Has shortness of breath or has trouble breathing.
• Develops severe throat pain, drooling, or changes in his or her voice.

These symptoms may represent a serious problem that is an emergency. Do not wait to see if the symptoms will go away. Get medical help right away. Call your local emergency services (911 in the U.S.).

Summary

• Rheumatic fever is a condition that can develop after an untreated strep throat infection. It causes inflammation that may affect the entire body.
• In some cases, rheumatic fever can cause serious damage to the heart.
• Most cases of rheumatic fever can be prevented with proper treatment of any strep throat infection.
• If your child was given an antibiotic medicine, give it to him or her as told by the health care provider. Do not stop giving the antibiotic even if he or she starts to feel better.