Rheumatic fever

Rheumatic fever is an infection caused by group A beta haemolytic streptococci (strep pyogenes) 

Diagnosis is by the revised Jones criteria, which is: 

• evidence of preceding streptococcal infection

• throat culture positive for bacteria
• positive rapid antigen detection test result
• elevated antistreptolysin O titre 
• scarlet fever 

                            OR

• chorea 

                           AND 

• 2 major criteria OR 1 major and 2 minor criteria 

Major criteria: 

• carditis 
• polyarthritis 
• chorea 
• erythema marginatum 
• subcutaneous nodules 

Minor criteria: 

• long PR 
• fever
• arthralgia 
• Raised ESR/CRP 

Treatment: 

• bed rest 
• aspirin 
• penicillin (or erythromycin if penicillin allergic) 
• possibly surgery if severe MR 
• prophylactic penicillin IM once monthly 
• for 5 years if acute rheumatic fever 
• OR until age 18 without proven carditis 
• OR 10yrs or until aged 25 if mild MR 
• OR lifelong if severe valve disease 

Prognosis:

• 60% of patients develop rheumatic heart disease, most commonly of the mitral valve 
• 10% recurrence of acute rheumatic fever within 5 years if no prophylaxis. 

References:

Cilliers, A. Rheumatic fever and its management. BMJ. 2006; 333(7579): 1153-1156. 

Madden, S. and Kelly, L. Update on acute rheumatic fever: it still exists in remote communities. Can Fam Phydician. 2009; 55(5): 475-478.