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Rheumatic Fever Rheumatic Fever
by Kimberly Allen, RN Rheumatic fever is an autoimmune disorder.  It is not caused by the bacteria but your immune systems response to it.  Rheumatic... Rheumatic Fever

by Kimberly Allen, RN

Rheumatic fever is an autoimmune disorder.  It is not caused by the bacteria but your immune systems response to it.  Rheumatic fever is usually diagnosed in children between 5-15 years of age but can occur at any age.Reumatic fever affects both boys and girls as well as all races.  Though the incidence of rheumatic fever has declined significantly in the US there are approximately 500,00 new cases diagnosed worldwide every year with approximately 250,000 deaths due to complications.  There are also approximately 15 million people worldwide suffering from rheumatic heart disease.

Rheumatic fever usually develops after either inadequately treating or untreated strep throat.  Researchers have not been able to determine a clear link between the strep bacteria and rheumatic fever, however, they believe that this particular bacterium has a protein that is similar to a protein found in cdrtain tissues in our body therefore tricking the immune system so that it attacks not only the bacterium but the healthy tissue containing the similar protein.  Those tissues most often affected are the heart, central nervous system, skin and joints.  The immune system response causes inflammation and tissue damage in the affected areas.

The symptoms of rheumatic fever vary from child to child and may even change during the time your child has the disease.  Symmptoms usually appear 4 -6 weeks after a strep throat infection.  The American Heart Association has developed a set of criteria known as the “Jones criteria” to assist Drs in diagnosing rheumatic fever.  There are majority criteria and minor criteria.  The major criteria include arthritis in multiple joints, inflammation of the heart, nodules under the skin known as Aschoff bodies, and a condtion known as Syndenham’s chorea which is characterized by rapid, jerky movements as well as a skin rash.  The minor criteria include fever, joint pain, an elevated ESR (estimated sedimentation rate) which indicates inflammation and changes in your childs electrocardiogram.  Berfore a diagnosis of rheumatic fever can be made your child must have a history of strep throat and have either two of the major criteria or one major and two minor criteria.

Treatment of rheumatic fever usually begins in an acute care facility due to the high potential for complications.  First the Dr will start your child on antibiotics.  Unless your child is allergic to
penicillin it will be penicillin or a penicillin derivitive.  If your child is allergic to penicillin there are other antibiotics your Dr can use.  If there is inflammation of the heart your child will need
high dose steroids to control the inflammation.  The most difficult symptom to treat is the involuntary movements known as Sydenham’s chorea.  Some Drs will prescribe anticonvulsants while  others find antipsychotics to be more effective.  Discuss the options and whats best for your child with your Dr.  Treatment of rheumatic fever involves long term antibiotic treatment , which means once your child has completed the intitial antibiotic treatment he/she will then need to take antibiotics until at least the age of 20, if he/she is an older teen he/she will need to take them until they have taken them for at least 5 years after the infection.

The only wat to prevent rheumatic fever is to get treatment for your child’s strep throat promptly.  Almost all cases of rheumatic fever diagnosed especially in the US are due to either under or untreated strep throat.  Youur child must complete the entire course of antibiotic therapy.  Unfortunately, too many people have told me they stop taking the antibiotics once they feel better saving the remaining antibiotics in case they or someone else in their family needs them later.  I can’t stress enough hoe dangerous this practice is and rhuematic fever is a prime example of what can happen when you do not complete the entire course of antibiotics prescribed by your Dr.

Kimberly Allen is a registered nurse with an AND in nursing. She has worked in ACF, LCF and psychiatric facilities, although she spent most of her career as a home health expert. She is now a regular contributor to, dispensing advice and knowledge about medical issues and questions. You can reach her with any comments or questions at