What Is Rheumatic Fever?

If you don’t treat your child's strep throat, he or she could develop a more serious infection called rheumatic fever, which produces inflammation throughout his or her body.

Many parents want to avoid giving their children antibiotics. But don’t skip antibiotics if your child develops strep fever, a common childhood infection. Left untreated, group A Streptococcus (or group A strep) can lead to several illnesses.

Rheumatic fever, one of these illnesses, can damage the heart.

What is rheumatic fever?

Like other infections, strep throat spreads when people gather close together, for example in daycare centers and schools. If you or your child has a sore throat that lasts longer than three days, or if she has a fever and headache along with a sore throat, get a throat culture. A fever and skin rash could also be caused by strep, even without a sore throat.

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Make sure your child finishes any prescribed antibiotics. Some people stop when they feel better after a couple of days. But strep can still multiply and affect his or her heart and other organs even if your child doesn’t have a sore throat anymore.

If an infection with group A strep lingers, about a week to 5 weeks later she could develop rheumatic fever, when the immune system causes inflammation throughout the body. Rheumatic fever can affect the heart, joints, brain, and skin.

It is most common in children ages 5 through 15, and rare before the age of 3. Although antibiotics have made rheumatic fever unlikely in the United States, it is still common in poorer countries.

Rheumatic fever can also follow scarlet fever, which is caused by the same bacteria. Although people with strep throat and scarlet fever can spread those illnesses, rheumatic fever is not contagious.

Teach your child to wash his or her hands often, especially before preparing foods or eating and after coughing or sneezing.

Your child can get strep infections, and rheumatic fever, more than once. Doctors think that some people are more vulnerable because of a weakened immune system. After one round of rheumatic fever, your child is more at risk of a second case in the next three years. After that the risk slowly fades.

What are the symptoms of rheumatic fever?

Symptoms include:

• Fever
• Arthritis — painful joints, usually in the knees, ankles, elbows, and wrists
• Chest pain, shortness of breath, fast heartbeat
• Fatigue
• Jerky, uncontrollable body movements (called “chorea”)
• Painless lumps (nodules) under the skin near joints (a rare symptom)
• Rash that appears as pink rings with a clear center (also rare)

Someone with rheumatic fever can also have:

• A new heart murmur
• An enlarged heart
• Fluid around the heart

How is rheumatic fever treated?

Always treat strep throat or scarlet fever with antibiotics. If your doctor suspects rheumatic fever, your child may be prescribed antibiotics even if a throat culture is negative.

Your child may need anti-inflammatory medicines to help decrease swelling in the heart muscle and ease joint pain.

Your child may need to stay in bed for 2 to 12 weeks.

Doctors may prescribe more antibiotics after a round of rheumatic fever, sometimes as a daily pill or a shot every few weeks or monthly. The goal is to protect the heart.

More than half the time, rheumatic fever leads to scarring in the heart valves. The valves narrow and may fail to open and close properly, which forces your heart to work harder. Eventually, your child may have rheumatic heart disease, which, in time, can end in congestive heart failure.

If your child’s heart is affected, she or he may not be able to participate in sports or any strenuous physical activity. Your child may also need to take antibiotics when having any dental work and may need surgery to repair or replace a damaged valve.

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