Although there's no single test for rheumatic fever, diagnosis is based on medical history, physical exam and certain test results.
If your child was already diagnosed with a strep infection, your doctor might not order additional tests for the bacterium. If your doctor orders a test, it will most likely be a blood test that can detect antibodies to the strep bacterium circulating in the blood. The actual bacterium might no longer be detectable in your child's throat tissues or blood.
Your doctor also is likely to check for inflammation in your child's blood by measuring C-reactive protein and the erythrocyte sedimentation rate.
Electrocardiogram (ECG or EKG)
This test — also called an ECG or EKG — records electrical signals as they travel through your child's heart. Your doctor can look for patterns among these signals that indicate inflammation of the heart or poor heart function.
Using sound waves to produce live-action images of the heart, this test can enable your doctor to detect heart abnormalities.
The goals of treatment for rheumatic fever are to destroy remaining group A streptococcal bacteria, relieve symptoms, control inflammation and prevent recurrences.
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 take the preventive antibiotic treatment for 10 years or longer.
- Anti-inflammatory treatment. Your doctor will prescribe a pain reliever, such as aspirin or naproxen (Naprosyn), 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 an anticonvulsant, such as valproic acid (Depakene) or carbamazepine (Carbatrol, Tegretol, others).
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.
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?
- as 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?