pediatrics
Rheumatic Fever
Key Points
Rheumatic fever is a nonsuppurative, acute, inflammatory complication of group A streptococcal (GAS) pharyngeal infection occurring most often initially between ages 5 years and 15 years. Symptoms and signs may include migratory polyarthritis, carditis, subcutaneous nodules, erythema marginatum, and chorea. Chronic rheumatic heart disease, particularly involving the mitral and/or aortic valves, may progress over decades and is a major cause of heart disease in the developing world. Diagnosis of acute rheumatic fever (ARF) requires 2 major or 1 major and 2 minor manifestations (modified Modified Jones Criteria for a First Episode of Acute Rheumatic Fever (ARF)* for a first episode of ARF) and evidence of GAS infection. Give antibiotics to eliminate GAS infection,aspirinto control fever and pain caused by arthritis and mild carditis, and corticosteroids for patients with moderate to severe carditis. Give prophylactic antistreptococcal antibiotics after the initial episode of ARF to prevent recurrences. 