Rheumatic Fever - Causes and diagnosis

Authored by Dr Oliver Starr, 06 Jul 2017

Patient is a certified member of
The Information Standard

Reviewed by:
Dr Laurence Knott, 06 Jul 2017

  • The disease starts with a throat or skin infection with a particular germ (bacterium) called a Lancefield group A beta-haemolytic streptococcus.
  • Usually this bug just causes a really sore throat or a bad skin infection which can be easily treated with the antibiotic penicillin.
  • For most people that is the end of the problem but in rheumatic fever your immune system goes into overdrive.
  • Your immune system thinks it can recognise bits of the streptococcus bug in your joints, heart and nervous system and so accidentally attacks them.
  • Until about the mid-1900s rheumatic fever was found in the UK and other western countries. But since antibiotics have become widespread it has practically disappeared from the UK.
  • In Africa, India and rural parts of Australia and New Zealand people still get rheumatic fever: roughly 1 in 300 teenagers will get it each year in those areas.
  • The disease is mainly related to a lack of antibiotics and also to poor social conditions like overcrowding.
  • The main age range is 8 to 14 years.
  • The peak age for the disease is 10 years old.
  • The diagnosis is usually made by the history of a sore throat or a bad skin infection followed, a few weeks later, by the typical features and symptoms.
  • A blood test to show a recent infection with the streptococcus bacterium (called an antistreptolysin titre) can help to confirm that the bacterium has been in your body.
  • But then there is a scoring system using major criteria and minor criteria. You need two majors, or one major and two minors, to make the diagnosis.
  • The major criteria are the main symptoms:
    • Joint pains.
    • Heart problems.
    • Jerky movements (called chorea).
    • Skin problems.
  • The minor criteria are:
    • A high temperature (fever), usually over 39°C.
    • A high blood test result showing inflammation in your body (what doctors call an ESR or a CRP).
    • Changes on a heart trace (what doctors call a prolonged PR interval).
  • To see the problems on the heart, a specialist will usually use an echocardiogram: a special scan to see the inside of the heart. But in many parts of the developing world there are not echocardiograms available.

Further reading and references

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