Rheumatic Fever

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Rheumatic fever is an illness that typically occurs in childhood. Rheumatic fever is not an infection, but rather the result of an untreated streptococcal infection, such as strep throat or scarlet fever. Rheumatic fever was more common before antibiotics. Today, it is seen in the United States in some children who have had strep infections that were untreated or inadequately treated. (An estimated two to three percent of people with untreated group A streptococcal pharyngitis will develop acute rheumatic fever.) Although rheumatic fever can occur at any age, it occurs most frequently in children five to fifteen years old.

When the body senses a strep infection, it sends antibodies to fight it. Sometimes these antibodies also attack the body's connective tissues — especially those of the heart, joints, brain or skin — causing an immune response. Many strains of strep produce an immune reaction in the body, particularly in young people, that can lead to rheumatic fever. (For more information, see symptoms, diagnosis, causes and prevention.)

Between 40 and 60 percent of children who have an attack of rheumatic fever have heart inflammation, which can involve both the heart valves (valvulitis) and heart muscle (myocarditis). A severe attack can result in congestive heart failure (a heart disease in which the heart enlarges and cannot pump out all its blood) and even death. Children may recover from the original heart inflammation, but may still have problems from the injured heart valves.

The valves on the left side of the heart (mitral and aortic valves) are most commonly affected. Frequent problems later in life are stenosis (narrowing) and insufficiency (leakage) of the mitral valve and insufficiency of the aortic valve. Permanent heart damage due to rheumatic fever is known as rheumatic heart disease.

There is no cure for rheumatic fever. The primary goal is to prevent rheumatic fever by treating a strep infection with the appropriate antibiotics. Children who have had rheumatic fever may need lifelong treatment with antibiotics to prevent further attacks, and will usually have to take preventive antibiotics before surgery or dental procedures, if they have long-lasting valve problems. The antibiotics help decrease the chance of infection in the heart valves related to a procedure such as dental work.

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