Learn about this serious complication of strep throat and scarlet fever and what you can do to prevent it.
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 ages 5 to 15. But 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.
Rheumatic fever can cause permanent damage to the heart, including damaged heart valves and heart failure. Treatment can ease pain, reduce damage from inflammation and prevent a recurrence of rheumatic fever.
Rheumatic fever symptoms result from inflammation in the heart, joints, skin or central nervous system. There may be few symptoms or several. Symptoms can change during the course of the disease. The onset of rheumatic fever usually occurs about 2 to 4 weeks after a strep throat infection.
Rheumatic fever signs and symptoms can include:
Make an appointment with your child's health care provider if any of these signs or symptoms of strep throat occur:
Proper treatment of strep throat can prevent rheumatic fever.
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. It appears that the bacteria trick the immune system into attacking otherwise healthy tissue.
The body's immune system typically targets infection-causing bacteria. In rheumatic fever, the immune system mistakenly attacks healthy tissue, particularly in the heart, joints, skin and central nervous system. This faulty immune system reaction results in swelling of the tissues (inflammation).
There's little chance of developing rheumatic fever when a strep throat infection is promptly treated with antibiotics and all the medication is taken as prescribed.
If a child has one or more episodes of strep throat or scarlet fever that aren't properly treated, rheumatic fever may occur.
Things that may increase the risk of rheumatic fever include:
Inflammation caused by rheumatic fever can last a few weeks to several months. For some people, the inflammation causes long-term complications.
One complication of rheumatic fever is permanent damage to the heart (rheumatic heart disease). Rheumatic heart disease usually occurs years to decades after the original illness.
However, severe rheumatic fever can start to damage the heart valves while your child still has symptoms of the infection. Damage is most common with the valve between the two left chambers of the heart (mitral valve), but the other valves can be affected.
Rheumatic fever can cause the following types of heart damage:
Damage to the heart valves or other heart tissues can lead to irregular, chaotic heartbeats (atrial fibrillation) or heart failure later in life.
The only way to prevent rheumatic fever is to treat strep throat infections or scarlet fever promptly and completely with a full course of appropriate antibiotics.
There's no single test for rheumatic fever. Diagnosis of rheumatic fever is based on medical history, a physical exam and certain test results. Tests for rheumatic fever might include:
Blood tests. Blood tests can be done to check for signs (markers) of inflammation in the blood. These tests include C-reactive protein and the erythrocyte sedimentation rate.
Sometimes, a blood test that can detect antibodies to the strep bacteria in the blood is done. The actual bacteria might no longer be detectable in the throat tissues or blood.
The goals of treatment for rheumatic fever are to treat the infection, relieve symptoms, control inflammation and prevent the condition from returning.
Treatment for rheumatic fever may include:
Antibiotics. Penicillin or another antibiotic is typically prescribed to treat the strep bacteria.
After the first antibiotic treatment is fully finished, a provider typically prescribes another course of antibiotics to prevent recurrence of rheumatic fever. Preventive treatment will likely continue through age 21 or until a child completes a minimum five-year course of treatment, whichever is longer.
People who have had heart inflammation during rheumatic fever might need to continue preventive antibiotic treatment for 10 years or longer.
Discuss with your care provider what type of follow-up and long-term care your child will need for rheumatic fever.
Heart damage from rheumatic fever, called rheumatic heart disease, might not show up for many years — even decades. Always tell your health care provider about any history of rheumatic fever.
A health care provider might recommend bed rest for a child with rheumatic fever. Activities may be restricted until inflammation, pain and other symptoms have improved. If inflammation affects the heart, strict bed rest may be recommended for a few weeks to a few months.
If your child has signs or symptoms of rheumatic fever, you're likely to start by seeing your child's pediatrician. Your child may be referred to a heart specialist (pediatric cardiologist) for some diagnostic tests.
Here's some information to help you get ready for the appointment.
Before the appointment, make a list of:
For rheumatic fever, basic questions to ask the health care provider include:
In addition to the questions that you've prepared to ask the health care provider, don't hesitate to ask questions during your appointment.
The health care provider is likely to ask questions, such as: