Rheumatic fever

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Symptoms

By Mayo Clinic staff

Rheumatic fever symptoms may vary. Some people may have several symptoms, while others experience only a few. The symptoms may also change during the course of the disease. The onset of rheumatic fever usually occurs about two to four weeks after a strep throat infection.

The signs and symptoms — which result from inflammation in the heart, joints, skin or central nervous system — may include:

  • Fever
  • Painful and tender joints — most often the ankles, knees, elbows or wrists; less often the shoulders, hips, hands and feet
  • Pain in one joint that migrates to another joint
  • Red, hot or swollen joints
  • Small, painless nodules beneath the skin
  • Chest pain
  • Sensation of rapid, fluttering or pounding heartbeats (palpitations)
  • Fatigue
  • Shortness of breath
  • Flat or slightly raised, painless rash with a ragged edge (erythema marginatum)
  • Jerky, uncontrollable body movements (Sydenham chorea or St. Vitus' dance) — most often in the hands, feet and face; less often in the arms and legs
  • Outbursts of unusual behavior, such as crying or inappropriate laughing, that accompanies Sydenham chorea

When to see a doctor
Your child should see a doctor if he or she has signs or symptoms of strep throat. Proper treatment of strep can prevent rheumatic fever. Call your doctor if your child has any of the following signs or symptoms:

  • A sore throat without cold symptoms, such as a runny nose
  • A sore throat accompanied by tender, swollen lymph glands (nodes)
  • Rash
  • Difficulty swallowing anything, including saliva
  • Thick or bloody discharge from the nose, which is more likely in children under 3 years of age

Children younger than 3 who have strep throat often have a low fever, while children over 3 with strep throat are likely to have a fever of 102 F (38.9 C) or higher. According to recommendations from the American Academy of Family Physicians, call your doctor about a fever in the following situations:

  • Infants under 3 months with a temperature of 100.4 F (38 C) or higher
  • Infants 3 to 6 months with a temperature of 101 F (38.3 C) or higher
  • Children 6 months to 2 years with a temperature of 103 F (39.4) or higher
  • Children 6 months or older with a temperature of 102 F (38.9) if the temperature continues to rise or lasts more than three days

Also, see your doctor if your child shows any other signs or symptoms of rheumatic fever.

Causes Definition
References
  1. Rheumatic fever. The Merck Manuals Online Medical Library: The Merck Manual for Healthcare Professionals. http://www.merck.com/mmpe/sec19/ch281/ch281a.html. Accessed Dec. 3, 2008.
  2. Carapetis JR, et al. Acute rheumatic fever. Lancet. 2005;366:155-168.
  3. Gibofsky A, et al. Epidemiology and pathogenesis of acute rheumatic fever. http://www.uptodate.com/home/index.html. Accessed Dec. 4, 2008.
  4. Gibofsky A, et al. Clinical manifestations and diagnosis of acute rheumatic fever. http://www.uptodate.com/home/index.html. Accessed Dec. 4, 2008.
  5. Hahn RG, et al. Evaluation of poststreptococcal illness. American Family Physician. 2005;71:1949-1954.
  6. Strep throat: Symptoms. National Institute of Allergy and Infectious Diseases. http://www3.niaid.nih.gov/topics/strepThroat/symptoms.htm. Accessed Dec. 15, 2008.
  7. Parenting corner Q&A: Sore throat. American Academy of Pediatrics. http://www.aap.org/publiced/BK0_SoreThroat.htm. Accessed Dec. 15, 2008.
  8. When your infant or child has a fever. American Academy of Family Physicians. http://familydoctor.org/online/famdocen/home/children/parents/common/common/069.html. Accessed Dec. 15, 2008.
  9. Gerber M. Streptococcus pyogenes (Group A streptococcus). In: Long S, et al., eds. Principles and Practice of Pediatric Infectious Diseases. 3rd ed. Philadelphia, Pa.: Churchill Livingstone/Elsevier; 2008. http://www.mdconsult.com/das/book/body/113823919-10/783584111/1679/122.html#4-u1.0-B978-0-443-06687-0..50121-1--cesec21_2521. Accessed Dec. 15, 2008.
  10. Weinberg G. Rheumatic fever. The Merck Manuals Online Medical Library: Home Edition for Patients and Caregivers. http://www.merck.com/mmhe/sec23/ch272/ch272h.html. Accessed Dec. 3, 2008.
  11. Gibofsky A, et al. Treatment and prevention of acute rheumatic fever. http://www.uptodate.com/home/index.html. Accessed Dec. 4, 2008.

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Jan. 23, 2009

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