RHEUMATIC FEVER |
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DESCRIPTIONRheumatic fever is an inflammatory complication of Group A streptococcal infections. It affects many parts of the body, especially the joints, heart, and heart valves, and sometimes the skin and brain. Strep infections are contagious, but rheumatic fever is not. Rheumatic fever affects children between ages 4 and 18.
Appropriate health care includes: physician's monitoring of general condition and
medications; home care after diagnosis (mild cases); hospitalization (severe cases).
SIGNS & SYMPTOMS
Joint inflammation, characterized by pain, redness, swelling, and warmth. The child's wrists, elbows, knees, or ankles are most often affected. Joint inflammation usually subsides in 10 to 14 days, but without treatment, other joints may become inflamed.
Fever.
Loss of appetite.
General ill feeling.
Mild skin rash on the chest, back, and abdomen.
Small, painless bumps just under the skin in body areas such as the elbows or knees.
Fatigue.
Paleness.
If the heart is involved:
Shortness of breath.
Fluid retention that causes swelling of the legs and back.
Rapid heartbeat, especially when lying down.
CAUSES
Rheumatic fever is caused by a preceding strep infection, usually in the throat, that occurs 1 to 6 weeks prior to the onset of the child's symptoms. It is probably an autoimmune disorder in which antibodies produced to attack the strep bacteria also attack tissues of the joints or heart.
RISK FACTORS
Poor nutrition; family history of rheumatic fever; crowded or unsanitary living conditions; untreated streptococcal infections.
PREVENTING COMPLICATIONS OR RECURRENCE
Request a throat culture for strep for your child from your doctor's office for any throat infection.
Obtain prompt antibiotic treatment for your child for any strep infection, including those of the skin. Strep infections must be treated with antibiotics, usually penicillin, for a minimum of 10 days orally or by long-lasting injection.
BASIC INFORMATION
MEDICAL TESTS
Your own observation of symptoms.
Medical history and physical exam by a doctor.
Laboratory studies, such as blood studies, a throat culture, and EKG (See Glossary).
X-rays of the chest and heart.
POSSIBLE COMPLICATIONSPermanently damaged heart valves, leading to congestive heart failure.
PROBABLE OUTCOME
Usually curable with treatment. In some cases, rheumatic fever may damage the child's heart valves. A damaged valve can be replaced with surgery. In rare cases, rheumatic fever is fatal -- even with treatment.
TREATMENT
HOME CARE
Take your child's temperature and count the pulse; keep a record for your doctor.
Use a cool-mist humidifier if the child has a sore throat or cough.
MEDICATION
Your doctor may prescribe:
Steroids (anti-inflammatory drugs) or aspirin to reduce inflammation.
Diuretics to reduce fluid retention.
Antibiotics to fight any remaining strep bacteria. Once rheumatic fever reaches the inactive stage, your child may continue taking low-dose antibiotics indefinitely to prevent recurrence.
ACTIVITY
Your child should stay in bed until laboratory studies show the disease has subsided. Bed rest for 2 to 5 weeks is usually required, but some cases require months. Provide a bedpan or bedside commode so the child won't have to get up to use the bathroom.
DIET & FLUIDS
Serve your child a liquid or soft diet in the early stages, progressing to a normal diet high in protein, calories, and vitamins.
OK TO GO TO SCHOOL?When signs of infection have decreased, appetite returns, and alertness, strength, and feeling of well-being will allow.
CALL YOUR DOCTOR IF
Your child has symptoms of rheumatic fever.
The following symptoms occur during treatment: swelling of the legs or back; shortness of breath; vomiting or diarrhea; cough; severe abdominal pain; fever of 101F (38.3C) or higher.
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