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Rheumatic Fever

Study guide:

An acute systemic inflammatory disease of children and young adults caused by pharyngeal infection with Group A beta-haemolytic streptococci (GAS).


  • Affects age between 5 and 15 years old.

  • Females > Males.

Estimated number of 12 million individuals suffered from RF and RHD worldwide.


  1. In genetically susceptible individuals, cross reactivity of M proteins of the infecting group A streptococci and cardiac myosin and laminin (the sarcolemmal membrane protein).

  2. Type II hypersensitivity.

  3. Typically 1-3 week following the onset of the pharyngeal GAS infection.

  4. GAS M proteins share epitopes with proteins found in synovium, heart muscle, and heart valve, suggesting that molecular mimicry contributes to the arthritis, carditis, and valvular damage.

Risk Factors:

  1. Genetic host risk factors.

  2. Under nutrition.

  3. Overcrowding.

  4. Lower socioeconomic status.


Clinical Presentation:

  • Jones criteria

* Diagnosis requires 2 major or 1 major and 2 minor. 

Heart failures symptoms (Dyspnea without rales, nausea and vomiting, epigastric ache, hacking, nonproductive cough, and marked lethargy and fatigue).


  1. Clinical (Jones criteria).

  2. ECG will show PR prolongation or ST segment and T wave changes.

  3. Echocardiography will detect carditis and differentiate between rheumatic carditis and other heart diseases.



  • Treatment of acute episode:

    1. High-dose aspirin (to reduce inflammation).

    2. Penicillin (to eliminate residual streptococcal infection).

  • Primary treatment (when the patient comes with sore throat but not yet developed the rheumatic fever):

    1. IM injection one dose (benzathine penicillin G). Erythromycin if allergic.

    2. If the ESR is high (indicating inflammation) à corticosteroids (Prednisone) or NSAIDs should be given until it stays normal for a week.

  • Secondary treatment (The patient already had rheumatic fever but we want to prevent it from occurring again):

    1. One injection of IM benzathine penicillin G every one month (sulfadiazine, then erythromycin if allergic).



  1. 50% of patients will eventually develop RHD.

  2. Some patients will have heart failure.


  • Kumarp,clarkm. Kumar&clark'sclinicalmedicine.8thed.edinburgh:saunders elsevier; 2012.

  • Colledgen,walkerb,ralstons.davidson'sprinciplesandpracticeofmedicine. 21st ed. London: elsevier; 2010.

  • Lillyl. Pathophysiology of heart disease.1sted.philadelphia:wolters kluwer/lippincott williams & wilkins; 2010.

  • Pesslerf,sherryd. Rheumatic fever: merckmanual professional[internet]. 2012 [13 may 2014]. Available from: fever.html

  • Lissauert,claydeng. Illustrated textbook of paediatrics. 4th elsevier; 2012.

  • Tally n, O’Connor’s. Clinical examination:a systematic guide to physical diagnosis. 6th ed. Australia: elsevier; 2010.

  • Erythema Marginatum - Pictures, Symptoms and Treatment [Internet]. 2015 [cited 25 December 2015]. Available from:

  • Riciu A. Rheumatic Fever Symptoms, Clinical Signs, Evolution And Treatment [Internet]. Doctor Tipster. 2011 [cited 25 December 2015]. Available from:

Written by:     Lama Al Luhidan

Reviewed by:    Roaa Amer

Format editor:  Bader Altamimi

Web Publisher: Bayan Alzomaili

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