Paediatrics: Rheumatic fever

Rheumatic fever

This is an important cause of heart disease worldwide, but rarely seen in developed countries. Acute rheumatic fever (ARF) develops in response to infection with group A B-haemolytic streptococcus. It is seen in child-ren aged 5–15yrs and incidence is highest in those from socially and eco-nomically disadvantaged areas.

Clinical features

·  There is a latent period of 2–6wks between onset of symptoms and previous streptococcal infection (e.g. pharyngitis).

·  Symptoms are non-specific.

·  The grouping together of clinical features makes the diagnosis more likely (Jones criteria).

·  These are categorized into major or minor.

Diagnosis of ARF

·  Two major features; or

·  One major + two minor features; and

·  Evidence of previous group A streptococcal infection.

Management

·In the acute phase treatment will include:

o bed rest;

o anti-inflammatory drugs (e.g. aspirin);

o corticosteroids (2–3wks);

o diuretics/ACE inhibitors if in heart failure;

o antibiotics (e.g. penicillin V for 10 days).

·Long-term therapy is aimed at s prevention of further attacks of acute rheumatic fever and the development of chronic rheumatic heart disease. Antibiotic prophylaxis (daily oral penicillin, or monthly IM penicillin G) is recommended.

Chronic rheumatic heart disease

Recurrent bouts of ARF with associated carditis result in scarring and fibrosis of the heart valves (most commonly mitral valve) and may result in incompetent valves requiring replacement.