What Are the Long-Term Side Effects of Rheumatic Fever?

Inflammation caused by acute rheumatic fever (RF) can damage every part of the heart, including the outer sac (the pericardium), inner lining (the endocardium), and valves. Rheumatic heart disease (RHD) refers to a group of both short-term (acute) and long-term (chronic) heart disorders that can develop because of RF.

• RHD is a condition in which RF may cause permanent damage to the heart valves.
• The heart valve is damaged by a disease process that typically begins with a strep throat caused by the bacterium Streptococcus and can progress to RF.
• RHD affects the heart valves, particularly the mitral valve.

Heart valve problems, which are frequently the result of RHD, can cause the following symptoms:

• Chest pain
• Excessive fatigue
• Heart palpitations (heart flutters)
• A thumping sensation in the chest
• Shortness of breath
• Swollen ankles, wrists, or stomach

If RF causes heart damage in childhood or young adulthood, daily antibiotics may be required until 25 or 30 years of age to help prevent RF recurrence and the development of infective bacterial endocarditis (an infection of the heart valves or lining). Additional treatment will be necessary depending on the type of heart damage.

Although streptococcus bacteria cause rheumatic fever (RF), the condition is not contagious. It is an autoimmune disease caused by streptococcal infection. In RF, post-infection, the body attacks its tissues, which is an autoimmune reaction.

RF is a multifaceted illness that affects the joints, skin, heart, blood vessels, and brain. It primarily affects children between 5 and 15 years of age. Symptoms typically appear one to five weeks after a child is infected with strep bacteria.

Although symptoms may differ from each child, they may include:

• Sore throat
• Inflammation in the joints that causes swelling, soreness, and redness
• Small, painless, hard bumps called nodules diagnosed under the skin, often over bony areas
• Uncharacteristic jerky movements (face and hands)
• A red rash with irregular edges on the torso, arms, or legs
• Fever
• Weight loss
• Lack of energy (fatigue)
• Stomach pain

It is a standard practice to treat rheumatic fever (RF) with oral antibiotics such as penicillin after a diagnosis. Aspirin or naproxen is added to reduce inflammation, fever, and pain. In extreme cases, a corticosteroid such as prednisone may be added.

• Following the initial attack, people are given continuous antibiotics to prevent further streptococcal infection and heart damage.
• People with established rheumatic heart disease (RHD) should take antibiotics daily. 
• Continuous antibiotics are usually administered through an injection every four weeks for a minimum of 10 years.
• Some people, such as those with severe complications, may need to be treated with antibiotics and corticosteroids for the rest of their lives. 
• People who develop severe RHD may require cardiac surgery to repair or replace the damaged heart valves.

RF is a rare but serious condition that necessitates medical attention. Early antibiotic treatment can help prevent long-term, serious complications such as RHD.