Diagnosis

Although there's no single test for rheumatic fever, diagnosis is based on medical history, a physical exam and certain test results.

Blood tests

If your child was already diagnosed with a strep infection using a throat swab test, your doctor might not order additional tests for the bacteria.

Sometimes, a blood test that can detect antibodies to the strep bacteria in the blood is done. The actual bacteria might no longer be detectable in your child's throat tissues or blood.

To test for rheumatic fever, your doctor is also likely to check for inflammation by measuring inflammatory markers in your child's blood, which include C-reactive protein and the erythrocyte sedimentation rate.

Electrocardiogram (ECG or EKG)

This test records electrical signals as they travel through your child's heart. The results can tell if the electrical activity of the heart is abnormal and can help your doctor determine if parts of the heart may be enlarged.

Echocardiogram

Sound waves are used to create live-action images of the heart, which can help your doctor to detect heart problems.

Treatment

The goals of treatment for rheumatic fever are to destroy remaining group A streptococcal bacteria, relieve symptoms, control inflammation and prevent the condition from returning.

Treatments include:

  • Antibiotics. Your child's doctor will prescribe penicillin or another antibiotic to eliminate remaining strep bacteria.

    After your child has completed the full antibiotic treatment, your doctor will begin another course of antibiotics to prevent recurrence of rheumatic fever. Preventive treatment will likely continue through age 21 or until your child completes a minimum five-year course of treatment, whichever is longer.

    People who have had heart inflammation during rheumatic fever might be advised to continue preventive antibiotic treatment for 10 years or longer.

  • Anti-inflammatory treatment. Your doctor will prescribe a pain reliever, such as aspirin or naproxen (Naprosyn, Naprelan, Anaprox DS), to reduce inflammation, fever and pain. If symptoms are severe or your child isn't responding to the anti-inflammatory drugs, your doctor might prescribe a corticosteroid.
  • Anticonvulsant medications. For severe involuntary movements caused by Sydenham chorea, your doctor might prescribe antiseizure medications, such as valproic acid (Depakene) or carbamazepine (Carbatrol, Tegretol, others).

Long-term care

Discuss with your doctor what type of follow-up and long-term care your child will need.

Heart damage from rheumatic fever might not show up for years. When your child grows up, he or she needs to include the information in his or her medical history and get regular heart exams.

Clinical trials

Explore Mayo Clinic studies testing new treatments, interventions and tests as a means to prevent, detect, treat or manage this disease.

Lifestyle and home remedies

Your doctor might recommend bed rest for your child and ask you to restrict his or her activities until inflammation, pain and other symptoms have improved. If inflammation is in heart tissues, your child might need strict bed rest for a few weeks to a few months, depending on the degree of inflammation.

Preparing for your appointment

If your child has signs or symptoms of rheumatic fever, you're likely to start by seeing your child's pediatrician. However, the doctor might refer you to a heart specialist (pediatric cardiologist) for some diagnostic tests.

Here's some information to help you get ready for the appointment.

What you can do

Before the appointment, make a list of:

  • Your child's symptoms, including any that seem unrelated to your reason for scheduling the appointment and any that have recently been resolved
  • Recent illnesses your child has had
  • All medications, vitamins or other supplements your child takes or has recently taken
  • Questions to ask your doctor

Take a family member or friend along, if possible, to help you remember the information you're given.

For rheumatic fever, basic questions to ask your doctor include:

  • What's likely causing my child's symptoms?
  • What other conditions could cause these symptoms?
  • What tests will my child need?
  • What is the best course of action?
  • Will rheumatic fever or its treatment affect my child's other health conditions?
  • How much do I need to restrict my child's activities?
  • Is my child still contagious? For how long?
  • What type of follow-up is needed?
  • Are there brochures or other printed material that I can have? What websites do you recommend?

In addition to the questions that you've prepared to ask your doctor, don't hesitate to ask questions during your appointment.

What to expect from your doctor

Your doctor is likely to ask you questions, such as:

  • When did your child's symptoms begin?
  • How have they changed over time?
  • Has your child had a cold or flu recently? What were the symptoms?
  • Has your child been exposed to strep throat?
  • Was your child recently diagnosed with strep throat or scarlet fever?
  • If so, did your child take all of the antibiotics as prescribed?

Rheumatic fever care at Mayo Clinic

Oct. 10, 2019
  1. Steer A, et al. Acute rheumatic fever: Epidemiology and pathogenesis. https://www.uptodate.com/contents/search. Accessed Aug. 27, 2019.
  2. Leal MTBC, et al. Rheumatic heart disease in the modern era: Recent developments and current challenges. Journal of the Brazilian Society of Tropical Medicine. 2019; doi:10.1590/0037-8682-0041-2019.
  3. Rheumatic fever. Merck Manual Professional Version. https://www.merckmanuals.com/professional/pediatrics/miscellaneous-bacterial-infections-in-infants-and-children/rheumatic-fever. Accessed Aug. 27, 2019.
  4. What about my child and rheumatic fever? American Heart Association. https://www.heart.org/en/health-topics/consumer-healthcare/answers-by-heart-fact-sheets/answers-by-heart-fact-sheets-cardiovascular-conditions. Accessed Aug. 27, 2019.
  5. Steer A, et al. Acute rheumatic fever: Treatment and prevention. https://www.uptodate.com/contents/search. Accessed Aug. 27, 2019.
  6. Rhodes KL, et al. Acute rheumatic fever: Revised diagnostic criteria. Pediatric Emergency Care. 2018; doi:10.1097/PEC.0000000000001511.
  7. Rheumatic fever. Arthritis Foundation. http://www.arthritis.org/about-arthritis/types/rheumatic-fever/. Accessed Aug. 27, 2019.
  8. AskMayoExpert. Acute rheumatic fever (ARF). Mayo Foundation for Medical Education and Research; 2016.
  9. Riggin EA. Allscripts EPSi. Mayo Clinic. Aug. 5, 2019.
  10. Yanagawa B, et al. Update on rheumatic heart disease. Current Opinion in Cardiology. 2016; doi:10.1097/HCO.0000000000000269.
  11. Mankad R (expert opinion). Mayo Clinic. Sept. 19, 2019.

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