Rheumatic fever

Diagnosis

Rheumatic fever cannot be diagnosed with a single test. Rheumatic fever is diagnosed based on medical history, a physical examination, and certain test results. Rheumatic fever tests may involve the following: 

• Blood tests: Blood tests can be used to look for indicators (markers) of inflammation. The erythrocyte sedimentation rate and C–reactive protein are among these tests. Blood can be tested to see if there are any strep bacteria antibodies present. The actual bacteria may no longer be found in the blood or tissues of the throat. 
• Electrocardiogram (ECG or EKG): Heart electrical activity is monitored during this test. It may help in the diagnosis of irregular heartbeats and assist a healthcare provider in figuring out whether any areas of the heart might be enlarged.
• Echocardiogram: Pictures of the beating heart are made using sound waves. An echocardiography demonstrates how the heart and heart valves function. 

Jones criteria: The Jones criteria may occasionally be used by healthcare providers to identify rheumatic fever. The child must meet two major criteria, or one major and two minor criteria, from the following lists in order to be diagnosed with rheumatic fever. Additionally, there needs to be experimental proof of an earlier infection with group A streptococcus.

• • Major criteria:
    • Arthritis of several joints.
    • Heart inflammation (carditis).
    • Bumps (nodules) under their skin.
    • Rapid, jerky movements (chorea).
    • Skin rash (erythema marginatum).
  • Minor criteria:
    • Fever.
    • Elevated erythrocyte sedimentation rate (ESR) or C–reactive protein (CRP) levels.
    • Arthralgia (joint pain).
    • EKG (electrocardiogram) changes.
    • History of previous rheumatic fever or rheumatic heart disease.

Treatment

The goals of rheumatic fever treatment is to treat the infection at first, followed by symptom relief, inflammation management, and relapse prevention. Rheumatic fever treatment options include: 

• Antibiotics: For the treatment of the underlying bacterial infection, healthcare providers prescribe antibiotics such as penicillin or another antibiotic.

• To prevent a recurrence of rheumatic fever, a healthcare provider often prescribes another course of antibiotics after the initial course has been completely completed. Preventive care will probably last until the child reaches age 21 or has finished a minimum five-year course of treatment, whichever is longer. People who have cardiac inflammation during rheumatic fever may require 10 years or more of prophylactic antibiotic therapy.
• Anti–inflammatory medication: A combination of aspirin and naproxen may be used to treat pain, fever, and inflammation. Additionally, this medicine may help with symptoms including pain in the joints.
• Corticosteroid may be recommended if the symptoms are severe or if the child fails to improve after using anti-inflammatory medications.
• Antiseizure drugs: The involuntary movements brought on by Sydenham chorea may be treated with medicines like valproic acid or carbamazepine.
• Long–term care: How the child will be treated for rheumatic fever in the long run should be discussed with the healthcare provider. Rheumatic heart disease, which is caused by rheumatic fever, may take years or even decades to manifest. Always disclose any prior rheumatic fever to the healthcare provider.