Main Page | See live article | Alphabetical index Rheumatic fever is an inflammatory disease which may develop after an infection with streptococcus bacteria (such as strep throat or scarlet fever) and can involve the heart, joints, skin, and brain. Table of contents 1 Causes 2 Symptoms 3 Signs 3.1 The major diagnostic criteria 3.2 The minor criteria 4 Treatment 5 Expectations 5.3 Complications 6 External link Causes Rheumatic fever is common worldwide and is responsible for many cases of damaged heart valves. While it is far less common in the United States since the beginning of the 20th century, there have been a few outbreaks since the 1980s. Rheumatic fever primarily affects children between ages six and 15 and occurs approximately 20 days after strep throat or scarlet fever. In up to a third of cases, the underlying strep infection may not have caused any symptoms. The rate of development of rheumatic fever in individuals with untreated strep infection is estimated to be 3 percent. Persons who have suffered a case of rheumatic fever have a tendency to develop flare-ups with repeated strep infections. Symptoms Fever Joint pain, migratory arthritis -- involving primarily knees, elbows, ankles, and wrists Joint swelling; redness or warmth Abdominal pain Skin rash (erythema marginatum) Skin eruption on the trunk and upper part of arms or legs Eruptions that are ring-shaped or snake-like in appearance Skin nodules Sydenham's chorea -- emotional instability, muscular weakness and rapid, uncoordinated jerky movements affecting primarily the face, feet and hands Epistaxis (nosebleeds) Cardiac (heart) involvement which may be asymptomatic or may result in shortness of breath, chest pain Signs Given the different manifestations of this disease, there is no specific test which can definitively establish a diagnosis. In addition to a careful physical examination of heart sounds, skin, and joints, blood samples may be taken as part of the evaluation. These include tests for recurrent strep infection, complete blood counts, and sedimentation rate. As part of the cardiac evaluation, an electrocardiogram may also be done. In order to standardize the diagnosis of rheumatic fever, several minor and major criteria have been developed. These criteria, in conjunction with evidence of recent streptococcal infection, establish a diagnosis of rheumatic fever. The major diagnostic criteria Carditis (heart inflammation) Polyarthritis Subcutaneous skin nodules Chorea (Sydenham's chorea) Erythema marginatum. The minor criteria Fever, arthralgia (joint pain), elevated erythrocyte sedimentation rate, and other laboratory findings. Two major criteria, or one major and two minor criteria, when there is also evidence of a previous strep infection support the diagnosis of rheumatic fever. Treatment The management of acute rheumatic fever is geared toward the reduction of inflammation with anti-inflammatory medications such as aspirin or corticosteroids. Individuals with positive cultures for strep throat should also be treated with antibiotics. Another important cornerstone in treating rheumatic fever includes the continuous use of low dose antibiotics (such as penicillin, sulfadiazine, or erythromycin) to prevent recurrence. Expectations The recurrence of rheumatic fever is relatively common in the absence of maintenance of low dose antibiotics, especially during the first three to five years after the first episode of rheumatic fever. Heart complications may be long-term and severe, particularly if the heart valves are involved. Complications Damage to heart valves (in particular, mitral stenosis and aortic stenosis) Endocarditis Heart failure Arrhythmias Pericarditis Sydenham's chorea External link NIH Rheumatic fever guide This article is from Wikipedia. All text is available under the terms of the GNU Free Documentation License.