If not promptly treated, rheumatic fever can have long-term side effects such as rheumatic heart disease, which weakens the valves between the heart’s chambers.
The majority of rheumatic fever (RF) symptoms go away after a few weeks or months, but recurrence and certain complications are common. Usually, heart and joint ailments are long-term consequences of RF.
The following are some of the long-term side effects of RF:
Heart valve damage:
- Rheumatic heart disease (RHD) is one of the most common complications of RF.
- With the first attack of RF, between 40 and 60 percent of people develop heart valve inflammation, which frequently results in permanent scarring of the heart valves.
- A scarred heart valve may obstruct adequate blood flow or cause blood to flow backward (valve regurgitation).
- Heart valve damage can appear even 10 to 30 years after the initial infection with the following complications:
- Valve stenosis (narrowing of the valve)
- Ruptured heart valve (medical emergency that may need surgery to replace or repair the heart valve)
- Atrial fibrillation (irregular heartbeat)
- Endocarditis (inflammation of the inner lining of the heart)
- Heart failure due to inflammation of the heart muscle
- Arrhythmias (abnormal heart rhythms)
- Pericarditis (inflammation of the sac surrounding the heart)
- Chest pain or angina
Other complications include:
- Joint pain due to arthritis
- Chronic skin disorders and sores
- Anemia
- Proteinuria (loss of protein in the urine that may be associated with kidney damage)
- Sydenham’s chorea (rapid, uncoordinated jerking movements primarily affecting the face, hands, and feet)
- Chronically enlarged lymph nodes
Complications during pregnancy and delivery may be seen that include heart failure. Before planning for pregnancy, women with RHD should consult with their doctor.
The long-term effects of RF can be disabling if your child experiences a severe case. Some of the side effects of RF may not manifest themselves for years. Be vigilant of long-term effects as your child grows older. If a child has a history of RF, the information should always be included in their permanent health history, even into adulthood, because they will need regular heart exams for the rest of their life.
Why is RHD a serious complication of RF?
Inflammation caused by acute rheumatic fever (RF) can damage every part of the heart, including the outer sac (the pericardium), inner lining (the endocardium), and valves. Rheumatic heart disease (RHD) refers to a group of both short-term (acute) and long-term (chronic) heart disorders that can develop because of RF.
- RHD is a condition in which RF may cause permanent damage to the heart valves.
- The heart valve is damaged by a disease process that typically begins with a strep throat caused by the bacterium Streptococcus and can progress to RF.
- RHD affects the heart valves, particularly the mitral valve.
Heart valve problems, which are frequently the result of RHD, can cause the following symptoms:
- Chest pain
- Excessive fatigue
- Heart palpitations (heart flutters)
- A thumping sensation in the chest
- Shortness of breath
- Swollen ankles, wrists, or stomach
If RF causes heart damage in childhood or young adulthood, daily antibiotics may be required until 25 or 30 years of age to help prevent RF recurrence and the development of infective bacterial endocarditis (an infection of the heart valves or lining). Additional treatment will be necessary depending on the type of heart damage.
Is rheumatic fever contagious?
Although streptococcus bacteria cause rheumatic fever (RF), the condition is not contagious. It is an autoimmune disease caused by streptococcal infection. In RF, post-infection, the body attacks its tissues, which is an autoimmune reaction.
RF is a multifaceted illness that affects the joints, skin, heart, blood vessels, and brain. It primarily affects children between 5 and 15 years of age. Symptoms typically appear one to five weeks after a child is infected with strep bacteria.
Although symptoms may differ from each child, they may include:
- Sore throat
- Inflammation in the joints that causes swelling, soreness, and redness
- Small, painless, hard bumps called nodules diagnosed under the skin, often over bony areas
- Uncharacteristic jerky movements (face and hands)
- A red rash with irregular edges on the torso, arms, or legs
- Fever
- Weight loss
- Lack of energy (fatigue)
- Stomach pain
What are the treatment options for rheumatic fever?
It is a standard practice to treat rheumatic fever (RF) with oral antibiotics such as penicillin after a diagnosis. Aspirin or naproxen is added to reduce inflammation, fever, and pain. In extreme cases, a corticosteroid such as prednisone may be added.
- Following the initial attack, people are given continuous antibiotics to prevent further streptococcal infection and heart damage.
- People with established rheumatic heart disease (RHD) should take antibiotics daily.
- Continuous antibiotics are usually administered through an injection every four weeks for a minimum of 10 years.
- Some people, such as those with severe complications, may need to be treated with antibiotics and corticosteroids for the rest of their lives.
- People who develop severe RHD may require cardiac surgery to repair or replace the damaged heart valves.
RF is a rare but serious condition that necessitates medical attention. Early antibiotic treatment can help prevent long-term, serious complications such as RHD.
SLIDESHOW
Sore Throat or Strep Throat? How to Tell the Difference See SlideshowLong-Term Outcomes from Acute Rheumatic Fever and Rheumatic Heart Disease: https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.115.020966
What are the long-term sequelae of acute rheumatic fever (ARF)? https://www.medscape.com/answers/236582-31438/what-are-the-long-term-sequelae-of-acute-rheumatic-fever-arf
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