Rheumatic Fever | Medtick
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Rheumatic Fever

What is it?

A rare disease where one has a reaction to a bacterial infection that has not been treated promptly or incorrectly, which can be recurrent and could cause rheumatic heart disease.

  • It normally affects children from 5-15 years of age.
  • Symptoms occur after several weeks of having a sore throat and can be difficult to diagnose.

Streptococcus bacteria are believed to trick your immune system into attacking healthy tissues in your body, the result of which is rampant inflammation that causing a number of symptoms.

Jones Criteria for Diagnosis of Acute Rheumatic Fever

Jones criteria are used to diagnose acute rheumatic fever (ARF) after a recent Group A Streptococcal (GAS) infection.

Diagnosis requires:

  • 2 Major criteria, and/or 1 Major + 2 Minor criteria PLUS evidence of preceding GAS infection.

Major Criteria

1. Carditis

  • Clinical or subclinical inflammation of the heart
  • May cause valvulitis (commonly mitral valve involvement)

2. Migratory Polyarthritis

  • Usually affects large joints (knees, ankles, elbows, wrists)
  • Moves from one joint to another

3. Sydenham Chorea

  • Involuntary, purposeless movements
  • Emotional instability and muscle weakness

4. Erythema Marginatum

  • Ring-shaped, non-itchy rash mainly on trunk and limbs

5. Subcutaneous Nodules

  • Small, painless nodules over bony prominences or tendons

Minor Criteria

  • Fever
  • Arthralgia
  • Raised ESR and/or CRP
  • Prolonged PR interval on ECG
  • Previous history of rheumatic fever or rheumatic heart disease (in some recurrence cases)

Evidence of Recent Group A Streptococcus (GAS) Infection:

 

  • Raised ASO titre , Anti-DNase B antibodies
  • Positive throat culture for Group A Streptococcus (GAS) infection.
  • Positive rapid antigen detection test

 

Diagnosis tests

  • Raised ASO titre , Anti-DNase B antibodies tests
  • Positive throat culture for Group A Streptococcus (GAS) infection.
  • Positive rapid antigen detection test
  • Echocardiography with Doppler – valvular inflammation and regurgitation.
  • ECG tests
  • Inflammatory tests
  • Blood tests

Cause

Symptoms

Symptoms occur several weeks after having a bacterial throat infection:

  • High temperature greater than 38°C (100°F) or over and/or chills and sweats longer than 72 hours?
  • Aching, painful muscles, muscle cramps/spasms/stiffness?
  • Involuntary movements (Muscle weakness: Jerky movements of the face, feet, and/or  hands)?
  • Joint stiffness and pain?
  • Night sweats?
  • Rapid heartbeat, swollen ankles and/or fingers?
  • General discomfort (muscle weakness), uneasiness or ill feeling (malaise) and/or fatigue (tiredness)?
  • Nose bleeds?
  • Dry cough longer than three weeks and/or breathing difficulties?
  • Abdominal pain and/or are constant violently vomiting or vomiting longer than two days (one day if a child)?
  • Rash on upper arms, legs and trunk (10% affected) which have a pale centre and redness in surrounding areas (ring-like) and fades and re-appear within hours and can be on or off for weeks to months (Erythema Marginatum)?
  • Swollen bumps on fingers, hands and/or toes (Osler nodes-red-purple, slightly raised, tender lumps often with a pale centre. Pain often precedes the development of the lesion by up to 24 hours and can last from hours to several days)?
  • Lumps under the skin over joint areas i.e. knuckles, elbows and knees, backbone and scalp (2% affected)?
  • Bleeding into skin on palms (at the base of the thumb and little finger) and/or sole of feet (Janeway lesions – tend to last days to weeks before healing totally)?
  • Irritated, depressed, anxiety and/or panic attacks?

Complications /Information to beware of/General tips:

Medical Emergency Condition

And/or do not wait, phone for an ambulance if have or develop:

This condition may show similar symptoms to:

Detailed Information

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