Rheumatic fever is a disease that may develop after an infection with group A streptococcus bacteria (such as strep throat or scarlet fever). It can cause severe illness in the heart, joints, skin, and brain.
Streptococcus - rheumatic fever; Strep throat - rheumatic fever; Streptococcus pyogenes - rheumatic fever; Group A streptococcus - rheumatic fever
Rheumatic fever is still common in countries that have a lot of poverty and poor health systems. It does not often occur in the United States and other developed countries. When rheumatic fever does occur in the United States, it is most often in small outbreaks. The latest outbreak in the United States was in the 1980s.
Rheumatic fever occurs after infections with a germ or bacteria called Streptococcus pyogenes or group A streptococcus. This germ appears to trick the immune system into attacking healthy tissues in the body. These tissues become swollen or inflamed.
This abnormal reaction seems to almost always occur with strep throat or scarlet fever. Strep infections that involve other parts of the body do not seem to trigger rheumatic fever.
Rheumatic fever mainly affects children ages 5 to 15 who have had strep throat or scarlet fever. If it occurs, it develops about 14 to 28 days after these illnesses.
Symptoms can affect many systems in the body. General symptoms may include:
Symptoms in the joints can:
Skin changes may also occur, such as:
A condition that affects the brain and nervous system, called Sydenham chorea, can also occur. Symptoms of this condition are:
Your health care provider will examine you and will carefully check your heart sounds, skin, and joints.
Tests may include:
Several factors called major and minor criteria have been developed to help diagnose rheumatic fever in a standard way.
The major criteria for diagnosis include:
The minor criteria include:
You'll likely be diagnosed with rheumatic fever if you:
If you or your child is diagnosed with acute rheumatic fever, you or your child will be treated with antibiotics. The goal of this treatment is to remove all of the strep bacteria from the body.
After the first treatment is complete, more antibiotics are prescribed. The goal of these medicines is to prevent rheumatic fever from recurring.
If you or your child had heart problems when the rheumatic fever occurred, antibiotics may be needed for even longer, perhaps for life.
To help manage swelling of inflamed tissues during acute rheumatic fever, medicines such as aspirin or corticosteroids may be needed.
For problems with abnormal movements or abnormal behaviors, medicines often used to treat seizures may be prescribed.
Rheumatic fever can cause severe heart problems and heart damage.
Long-term heart problems can occur, such as:
Contact your provider if you or your child develops symptoms of rheumatic fever. Because several other conditions have similar symptoms, you or your child will need careful medical evaluation.
If symptoms of strep throat develop, tell your provider. You or your child will need to be checked and treated if strep throat is present. This will decrease the risk of developing rheumatic fever.
The most important way to prevent rheumatic fever is by getting quick treatment for strep throat and scarlet fever.
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Shulman ST, Jaggi P. Nonsuppurative poststreptococcal sequelae: rheumatic fever and glomerulonephritis. In: Bennett JE, Dolin R, Blaser MJ, eds. Mandell, Douglas, and Bennett's Principles and Practice of Infectious Diseases. 9th ed. Philadelphia, PA: Elsevier; 2020:chap 198.
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Reviewed By: Linda J. Vorvick, MD, Clinical Associate Professor, Department of Family Medicine, UW Medicine, School of Medicine, University of Washington, Seattle, WA. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.