Rheumatic fever is a disease that can occur after an infection caused by the Group A Streptococcus bacteria. If left untreated (in the same way as a “strep throat” infection), it can lead to a delayed complication characterized by widespread inflammation in other parts of the body, particularly joints, heart, skin, and brain.

This disease is classified as autoimmune due to the inflammation that is likely caused by an immune system reaction to bacteria. Although it can develop at any age, children between the ages of five and fourteen are most at risk. The disease can cause severe complications, such as rheumatic heart disease if left untreated. 

Only a small percentage of people who have had a strep infection will develop rheumatic fever. It is an illness that can occur after an untreated bacterial Streptococcus infection. Without treatment, it can lead to serious complications such as rheumatic heart disease. The disease is rare, with the exception of remote parts where people, especially children, are most at risk.

Symptoms of rheumatic fever

Most of the symptoms associated with this medical condition go away with medical treatment. Rheumatic fever symptoms can include:

• sudden onset of symptoms
• Fever
• Painful and inflamed joints
• Fatigue
• Skin problems such as a rash (erythema marginatum) or lumps under the skin around the affected joints
• unexplained weight loss
• Nervous system problems, such as involuntary movements and spasms
• Heart problems, such as inflammation (carditis), enlargement of the heart (cardiomegaly), fast heartbeat (tachycardia), or heart murmur
• Shortness of breath
• Chest pain

If you experience any of the above-mentioned symptoms, consult a rheumatic fever specialist immediately for treatments.

Does rheumatic fever cause heart problems?

Typically, the rheumatic disease develops after recurrent or long-term bouts of rheumatic fever in childhood. However, it can also develop after a single ‘attack’ of fever. Rheumatic heart disease can be a permanent complication.

Several structures in the heart can be damaged by inflammation, including its muscles, linings, or valves. Sometimes, rheumatic heart disease is asymptomatic. In other cases, the person may have a variety of rheumatic heart disease symptoms, including shortness of breath, chest pain, and palpitations.

Many children who have the condition go undiagnosed or untreated. This is why the incidence of rheumatic heart disease is high in some of the communities.

Socio-economic risk factors

Untreated streptococcal infections can lead to rheumatic fever. Certain living conditions make strep throat more likely to occur. Poor living conditions, overcrowding, and limited access to health care are known risk factors. It is thought that strep bacteria can also enter the body through cuts in the skin and abrasions. 

Diagnosis

There is no specific rheumatic fever diagnosis test available to diagnose the condition. The range of tests may include:

• Medical history, including evidence of a previous streptococcal infection
• Physical exam
• Swabs of the throat are tested for the presence of Group A Streptococcus bacteria
• Blood tests to check for “markers” that indicate inflammation
• Monitoring electrical activity in the heart with an electrocardiogram (ECG)
• Chest X-rays to check the heart for signs of enlargement and to check the lungs for congestion.

Rheumatic fever treatment

Treatment may include:

• hospital admission
• Penicillin, usually given as an intramuscular injection
• aspirin course
• Corticosteroids (cortisone), if the arthritis is severe or if there is carditis (inflammation of the heart)
• Long-term antibiotic treatment, which may include monthly injections of penicillin, for up to five years (which helps reduce the risk of rheumatic heart disease)
• In the case of rheumatic heart disease, treatment with a cardiac catheter or surgery to repair damaged heart valves may be necessary.

Prognosis

With timely and adequate medical care, the long-term prospects are excellent. However, having this condition once does not provide immunity against a recurrence. It is important for the person to seek immediate medical attention for any future strep throat. Currently, there is no vaccine for rheumatic fever, but scientists are working towards finding a suitable solution against Streptococcus. A vaccine that prevents streptococcal infections would also be expected to prevent the condition as well as rheumatic heart disease.

FAQ

Who is most susceptible to rheumatic fever?

Rheumatic fever can affect anyone, but it is more common in school-age children (5 to 15 years old). Adults and Children younger than three years of age are not likely to get rheumatic fever. When large groups of people get together, infectious diseases, such as group A strep, tend to spread.

What happens if rheumatic fever is not treated?

Untreated rheumatic fever can cause chronic heart damage (called rheumatic heart disease). The valves between the heart’s chambers become weak due to rheumatic heart disease. Heart surgery is sometimes required to treat severe rheumatic heart disease.

Is rheumatic fever curable?

Rheumatic fever treatment aims to destroy remaining group A streptococcal bacteria, reduce symptoms, control inflammation, and prevent recurrence.

Is it possible to have rheumatic fever without knowing it?

In many cases, the symptoms of rheumatic fever are so mild that you’re not even aware of it. Fever, Painful and tender joints, mostly in the ankles, knees, elbows, and wrists are some of the symptoms of rheumatic fever.