Pediatric Rheumatic Fever

Rheumatic fever is a complex disease that affects the joints, skin, heart, blood vessels and brain. It occurs mainly in children between the ages of 5 to 15. It is an autoimmune disease that occurs after an infection with strep (streptococcus) bacteria. Strep infections include strep throat and scarlet fever. Rheumatic fever happens more often in the winter and spring. This is because strep throat infections occur more often in these seasons. Strep is contagious. This means it can be spread from child to child. But rheumatic fever is not contagious.

Rheumatic fever is an autoimmune reaction to the strep bacteria. An autoimmune reaction is when the body attacks its own tissues. It can be prevented if strep throat is diagnosed right away and treated correctly with antibiotics. Rheumatic fever is not common in the U.S.

Children ages 5 to 15 are most at risk for having rheumatic fever. They are most at risk if they:

• Have strep throat infections often
• Have strep infections that were not treated or not treated enough
• Have a family history of rheumatic fever

The symptoms usually start about one to five weeks after a child has been infected with strep bacteria. Each child’s symptoms may vary. Common symptoms can include:

• Inflammation in joints such as the knees or ankles that causes swelling, soreness, and redness
• Small, painless, hard bumps (nodules) under the skin, often over bony areas
• Unusual jerky movements, most often of the face and hands. This is often noted by a change in a child's handwriting.
• Red rash with odd edges on the torso, arms or legs
• Fever
• Weight loss
• Lack of energy (fatigue)
• Stomach pains

These symptoms can seem like other health conditions. Have your child see their healthcare provider for a diagnosis.

Your child’s healthcare provider will take your child’s health history and do a physical exam. Your child may also have tests such as:

• Blood tests. These are done to look for signs of inflammation, recent strep infection, and other related problems.
• Electrocardiogram (ECG). This is a test that records the electrical activity of the heart. It shows abnormal rhythms and detects heart muscle damage.
• Throat culture. A swab is wiped on the throat. This is done to look for the strep bacteria. 

Your child's healthcare provider will look for:

• Inflammation of the heart
• Inflammation of more than one joint
• Unusual jerky movements
• Small, hard bumps under the skin
• Red, irregular rash
• Fever
• Pain in one or more joints
• Previous inflammation of the heart
• Changes in the ECG pattern
• Abnormal sedimentation rate or C-reactive protein in blood tests

Treatment will depend on your child’s symptoms, age and general health. It will also depend on how severe the condition is.

Treatment for rheumatic fever often combines the following three things:

• Treatment for strep. The first step is to treat the strep infection with antibiotics. This is done even if a throat culture is negative. Your child may need to take monthly doses of antibiotics to prevent future strep infections. This is to help prevent the rheumatic fever from recurring and further damaging the body.
• Anti-inflammatory medicines. Your child may take medicines to help decrease the swelling that occurs in the heart muscle. These medicines also help ease joint pain.
• Bed rest. The length of bed rest will depend on how severe your child's illness is. Bed rest may range from two to 12 weeks.

Talk with your child’s healthcare provider about the risks, benefits and possible side effects of all medicines.

If the illness severely attacks a child's heart, this may damage heart valves and cause heart disease. In this case, your child may not be allowed to do some kinds of physical activity and sports.

If the heart were damaged, your child would need to take special care when going to the dentist in the future. They may need to take antibiotics before having dental work done. This helps lower the chance of an infection traveling to the heart during a dental procedure. Talk with your child's healthcare provider for more information.

Many cases of rheumatic fever may be prevented by quickly and correctly treating strep throat with antibiotics.

Having rheumatic fever increases your child's chances of having the disease again. This is at highest risk during the first three years. The chance of having the disease again lessens with age and time.

After having rheumatic fever, your child will need to take antibiotics every month. These are to help lessen the chance of having rheumatic fever again. Often by the time a child is 18, the antibiotic therapy may be stopped. Close follow-up with your child's healthcare provider is needed.

Call the healthcare provider if your child's symptoms get worse or they have new symptoms.