Rheumatic fever for nurses and nursing students:
Rheumatic fever is an inflammatory illness that occurs as a complication of strep throat that may not have been treated correctly. Scarlet fever which is different from rheumatic fever, and strep throat are also caused by a group A streptococcus bacterial infection.
Rheumatic fever can occur in younger children and adults, however, it is most common in children ages 5 – 15 years old. While rheumatic fever is most common in developing countries, it is rare in the United States.
Rheumatic fever causes long lasting damage to the heart valves and possibly heart failure.
Signs and Symptoms
The sign and symptoms of rheumatic fever can differ from patient to patient. Rheumatic fever can occur within two to four weeks after a strep throat infection. These signs and symptoms include:
- Sore throat
- pain in a joint that radiates to another
- Tender and painful joints- examples include elbows, ankles, hips, hands, and knees
- Hot and red swollen joints
- Heart murmur
- Chest pain
- Erythema marginatum – a flat painless rash that is slightly raised.
- Unusual behavior
- Sydenham chorea – uncontrollable jerky movements
- Rheumatoid nodules
Rheumatic fever usually occurs after a throat infection such as strep throat or scarlet fever which is caused by a bacteria called group A streptococcus or Streptococcus pyogenes. Rheumatic fever may also be caused by group A streptococcus infections of the skin or other parts of the body.
It is not clear what the connection is between rheumatic fever and strep infection. One theory is that the strep bacterium has a protein that mimics the protein found in body tissues. Because of this similarity, the immune system ends up attacking the body’s own cells as if they were infectious agents.
If the patient gets quick and complete care including antibiotics to eliminate the strep bacteria, there is a very little chance that they will develop rheumatic fever.
Type of strep bacteria: some strains are more likely to cause rheumatic fever than others.
Family history: a parent could be a carrier of the genes that predispose the patient to get rheumatic fever.
Environment: crowded and close living situations with poor hygiene can contribute to rheumatic fever.
Inflammation may last for a few weeks or several months. This inflammation may cause long lasting challenges for the patient.
Rheumatic heart disease is the caused by the inflammation of rheumatic fever, here we see the permanent damage to the heart valve. Problems are most common with the mitral valve, however, other valves may be affected. This damage may cause one of the following conditions:
- Valve regurgitation: leak in the valve = allows blood to flow in wrong direction.
- Valve Stenosis: narrowing of the valve = decreased blood flow.
- Damage to heart muscle: poor pumping action due to damaged heart muscle.
Damage to the heart valves can lead to other problems with the heart later on in life. This can include:
- Heart failure
- Atrial fibrillation
- Tests for strep this can be done by bloodwork or throat culture.
- Electrocardiogram – this exam uses sound waves to show the heart in action. It may detect structures (valves ) that have been altered in the heart.
- Antibiotics – the goal for treatment is to destroy group A streptococcal bacteria. Usually penicillin is given but the physician may use another antibiotic instead. * antibiotic treatment may be required for up to 5-10 years.
- Anti-inflammatory agents – a pain reliever may be prescribed to reduce inflammation. If anti-inflammatory agents are not working, a corticosteroid may be prescribed instead.
- Anticonvulsants – may be prescribed if Sydenham chorea (involuntary movements) are severe.
It is important to note that heart damage from rheumatic fever may not show up until years after an illness.
The medical information on this site is provided as an information resource only, and is not to be used or relied on for any diagnostic or treatment purposes. This information is not intended to be patient education and should not be used as a substitute for professional diagnosis and treatment.