Acute rheumatic fever

Alternative names

Rheumatic fever

Definition

Rheumatic fever is an inflammatory disease which may develop after an infection with streptococcus bacteria (such as strep throat or scarlet fever) and can involve the heart, joints, skin, and brain.

Causes, incidence, and risk factors

Rheumatic fever is common worldwide and is responsible for many cases of damaged heart valves. While it is far less common in the U.S. since the beginning of the 20th century, there have been a few outbreaks since the 1980s.

Rheumatic fever primarily affects children between ages 6 and 15 and occurs approximately 20 days after strep throat or scarlet fever. In up to a third of cases, the underlying strep infection may not have caused any symptoms.

The rate of development of rheumatic fever in individuals with untreated strep infection is estimated to be 3%. Persons who have suffered a case of rheumatic fever have a tendency to develop flare-ups with repeated strep infections.

Symptoms

• Fever
  
• Joint pain, migratory arthritis - involving primarily knees, elbows, ankles, and wrists
  
• Joint swelling; redness or warmth
  
• Abdominal pain
  
• Skin rash (erythema marginatum)
  o Skin eruption on the trunk and upper part of arms or legs
  o Eruptions that are ring-shaped or snake-like in appearance
  
• Skin nodules
  
• Sydenham's chorea - emotional instability, muscular weakness and rapid, uncoordinated jerky movements affecting primarily the face, feet and hands
  
• Epistaxis (nosebleeds)
  
• Cardiac (heart) involvement which may be asymptomatic or may result in Shortness of breath, chest pain
  

Signs and tests

Given the different manifestations of this disease, there is no specific test which can definitively establish a diagnosis. In addition to a careful physical examination of heart sounds, skin, and joints, blood samples may be taken as part of the evaluation. These include tests for recurrent strep infection (ASO or antiDNAse B), complete blood counts, and sedimentation rate (ESR). As part of the cardiac evaluation, an electrocardiogram may also be done.

In order to standardize the diagnosis of rheumatic fever, several minor and major criteria have been developed. These criteria, in conjunction with evidence of recent streptococcal infection, establish a diagnosis of rheumatic fever.