Rheumatic fever is an inflammatory disorder of the connective tissue of the body, triggered by strep throat infection. This condition causes temporary, painful arthritis and other symptoms.
In some cases rheumatic fever causes long-term damage to the heart and its valves. This is called rheumatic heart disease.
Rheumatic fever occurs as a result of a rare strain of strep throat that isn’t treated with antibiotics quickly enough or at all. Doctors aren’t sure why this rare strain of strep triggers this inflammatory disorder. It’s probably because antibodies (special proteins in the blood that attack strep) mistakenly also attack healthy cells, such as the cells in the valves in the heart, causing a reaction that results in inflammation.
Strep throat is most common in school-aged children, and so is rheumatic fever. Rheumatic fever was a leading cause of death in children in the United States before 1960. Today it is not common in the United States because most people have access to penicillin and other antibiotics. However, it remains a leading cause of early death in countries with less-developed healthcare systems.
Doctors believe that there is a genetic factor in rheumatic fever: Some families are much more likely to develop it. Researchers are looking for the reasons.
Rheumatic fever can cause:
Penicillin, aspirin and other medicines are used to treat rheumatic fever. Children will probably have to stay on a low dose of penicillin for years to reduce the risk of recurrence. It is very important to prevent a recurrence because of the risk of more damage to the heart.
Carditis, or inflammation of the heart muscle and tissue, is the most serious result of rheumatic fever. Some children don’t develop carditis, while others develop mild carditis that may not cause problems in the future.
However, some children develop severe carditis. The inflammation leads to scarring and permanent damage to the heart, particularly the valves. The mitral valve, which controls the flow of blood between the upper left chamber and the lower left chamber of the heart, is most often damaged. If the valve starts to leak, surgery to replace or repair it may be necessary. Usually this isn’t necessary before adulthood.
Children who have serious rheumatic heart disease will need to see a cardiologist regularly for the rest of their lives. The doctor will monitor heart function so that, if problems develop, they can be addressed as quickly as possible.
Contact the Cardiac Center at The Children's Hospital of Philadelphia for a second opinion or for more information.
Reviewed by: Richard Donner, MD
Date: February 2010
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