Rheumatic fever is a systemic condition that can affect the heart, joints, skin, and nervous system. It usually develops after an untreated or poorly treated streptococcal throat infection, commonly in children aged 3–15 years. Early diagnosis and treatment are essential to prevent serious heart complications later in life.
If your child or a family member is experiencing joint pain, fever, or unusual involuntary movements, you can get personalised advice from licensed doctors through Hope Plus. This service helps you access timely care and reduce the risk of long-term complications.
Key Takeaways
- Rheumatic fever follows a streptococcal throat infection and can affect the heart, joints, skin, and nervous system.
- Common signs include migrating joint pain, fever, heart murmurs, skin rashes, subcutaneous nodules, and involuntary movements (chorea).
- Diagnosis involves blood tests (including ASO titre), ECG, echocardiography, and chest X-ray.
- Early antibiotic treatment and anti-inflammatory medicines can prevent heart damage.
- Long-term prophylaxis is required to prevent recurrence, especially in children and those with heart involvement.
Causes
- Hypersensitivity reaction to group A streptococcal throat infection.
Symptoms and Clinical Features
- Major manifestations:
- Polyarthritis (migrating asymmetric joint pain)
- Carditis (inflammation of the heart, sometimes with heart failure or murmurs)
- Erythema marginatum (rash)
- Subcutaneous nodules
- Sydenham’s chorea (involuntary movements of the limbs)
- Minor manifestations:
- Fever
- Polyarthralgia (joint aches)
- Elevated inflammatory markers (ESR, CRP)
- ECG changes (prolonged PR interval)
Differential Diagnosis
- Other causes of arthritis or joint pain, including sickle cell disease and hemophilia
- Fever with cardiac involvement from other conditions
Investigations
- Blood tests: complete blood count, ESR, CRP, and antistreptolysin O titre (ASOT)
- ECG
- Chest X-ray
- Echocardiography
- Throat swab for group A beta-hemolytic streptococcus
Treatment
General Care
- Bed rest until acute symptoms resolve
Antibiotic Therapy
- Phenoxymethylpenicillin (Pen V): 250 mg every 6 hours for 10 days
- Child: 125 mg per dose
- Benzathine benzylpenicillin: 1.2 MU IM single dose
- Child <30 kg: 0.6 MU
- Child ≥30 kg: 1.2 MU
Anti-inflammatory Therapy
- Acetylsalicylic acid (aspirin): 4–8 g/day in divided doses until inflammation subsides (usually 4–8 weeks)
- Child: 80–100 mg/kg/day in 3 doses
- Magnesium trisilicate: 2–4 tablets every 8 hours, taken 30 minutes after aspirin
- If allergic to aspirin: low-dose corticosteroids may be used
Management of Complications
- Carditis/heart failure: Follow heart failure guidelines; high-dose steroids may be considered (specialist only)
- Chorea: Valproate 10–20 mg/kg/day
Long-Term Prophylaxis
- To prevent recurrence:
- Pen V 500 mg every 12 hours
- Child: 125–250 mg every 12 hours
- OR Benzathine benzylpenicillin 1.2 MU IM every 4 weeks
- Child <30 kg: 0.6 MU
- Pen V 500 mg every 12 hours
- If allergic to penicillin: Erythromycin 250 mg every 12 hours
- Child: 10 mg/kg twice a day
- Duration depends on severity:
- Rheumatic fever without carditis: 5 years or until age 18–21
- Carditis without residual heart disease: 10 years or until age 25
- Carditis with residual heart disease: until age 40–45 or lifelong
Prevention
- Early diagnosis and treatment of strep throat
- Avoid overcrowding and ensure good housing
- Maintain good nutrition
Frequently Asked Questions
Can rheumatic fever cause permanent heart damage?
Yes. If left untreated, it can cause rheumatic heart disease, affecting heart valves and leading to long-term complications.
How soon after a sore throat does rheumatic fever occur?
Typically 2–4 weeks after an untreated streptococcal throat infection.
Is it common in Uganda?
Rheumatic fever is more common in children living in areas with limited access to antibiotics and healthcare.
How can I prevent recurrence?
Adherence to long-term prophylactic antibiotics and prompt treatment of future strep infections are essential.
