Rheumatic Fever Follow-up

  • Author: Mark Raymond Wallace, MD; Chief Editor: Burke A Cunha, MD   more...
 
Updated: Apr 13, 2009
 

Further Inpatient Care

  • Most patients with acute rheumatic fever (ARF) can be treated at home.
  • Inpatient care may be appropriate when the patient has severe constitutional symptoms, chorea, carditis with CHF, or major toxicity with the anti-inflammatory drugs.
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Further Outpatient Care

Patients should be closely observed until all acute symptoms have resolved and they have returned to their normal state of health. Secondary prophylaxis requires years of follow-up and is the critical step in maintaining the health of the recovered patient (see Medication).

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Inpatient & Outpatient Medications

  • Patients with ARF need prolonged antibiotic prophylaxis to prevent recurrent attacks (see Medication).
  • The anti-inflammatory drugs are not usually required for more than 4-8 weeks.
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Deterrence/Prevention

Primary prophylaxis (treatment of streptococcal pharyngitis) dramatically reduces the risk of ARF and should be provided whenever possible. Secondary prophylaxis is essential in all patients with rheumatic fever (see Medication).

Ultimately, a vaccine will be the prevention of choice for ARF. Research on such a product is ongoing.[26]

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Complications

  • Immediate complications
    • Pancarditis that causes CHF, heart blocks, or pericardial effusion requires emergent inpatient care and cardiology evaluation.
    • Chorea can present months after the inciting infection and can be quite debilitating.[14]
  • Long-term sequelae
    • The only long-term sequela is rheumatic heart disease, which can present years later as valvular stenosis, most commonly involving the mitral valve. These patients are prone to infective endocarditis and stroke.
    • Valvular stenosis can lead to heart failure and may require surgery.
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Prognosis

  • The prognosis of ARF has been improved greatly by preventing recurrent attacks with secondary antimicrobial prophylaxis. The ultimate prognosis of an individual attack is related directly to the severity of cardiac involvement during the acute phase.
  • About 60% of patients with carditis improve over a decade; in some, murmurs disappear. However, the overall prognosis is worse in those with severe carditis at first presentation,[6] and most develop significant rheumatic heart disease.
  • Only 6% of patients without carditis (or questionable carditis) during their attack of ARF have an audible heart murmur in 10 years.
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Patient Education

  • Patients, especially children, should receive medical attention when they develop a sore throat. Compliance with oral primary prophylaxis ("strep throat" treatment) and secondary prophylaxis regimens is essential to prevent ARF and its sequelae.
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Contributor Information and Disclosures
Author

Mark Raymond Wallace, MD  Infectious Disease Fellowship Director, Orlando Regional Healthcare; Clinical Professor of Medicine, Florida State University

Mark Raymond Wallace, MD is a member of the following medical societies: American College of Physicians, American Medical Association, American Society of Tropical Medicine and Hygiene, and Infectious Diseases Society of America

Disclosure: Nothing to disclose.

Coauthor(s)

Larry I Lutwick, MD  Professor of Medicine, State University of New York, Downstate Medical School; Director, Infectious Diseases, Veterans Affairs New York Harbor Health Care System, Brooklyn Campus

Larry I Lutwick, MD is a member of the following medical societies: American College of Physicians and Infectious Diseases Society of America

Disclosure: Nothing to disclose.

Jayashree Ravishankar, MD  Fellow, Department of Medicine, Division of Infectious Diseases, State University of New York Health Science Center at Brooklyn

Jayashree Ravishankar, MD is a member of the following medical societies: American College of Physicians and Infectious Diseases Society of America

Disclosure: Nothing to disclose.

Specialty Editor Board

Thomas J Marrie, MD  Chair, Professor, Department of Medicine, Division of Infectious Diseases, University of Alberta College of Medicine

Thomas J Marrie, MD is a member of the following medical societies: Alpha Omega Alpha, American College of Physicians, American Society for Microbiology, Canadian Infectious Disease Society, and Royal College of Physicians and Surgeons of Canada

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Senior Pharmacy Editor, eMedicine

Disclosure: Nothing to disclose.

Richard B Brown, MD, FACP  Chief, Division of Infectious Diseases, Baystate Medical Center; Professor, Department of Internal Medicine, Tufts University School of Medicine

Richard B Brown, MD, FACP is a member of the following medical societies: Alpha Omega Alpha, American College of Chest Physicians, American College of Physicians, American Medical Association, American Society for Microbiology, Infectious Diseases Society of America, and Massachusetts Medical Society

Disclosure: Nothing to disclose.

Eleftherios Mylonakis, MD  Clinical and Research Fellow, Department of Internal Medicine, Division of Infectious Diseases, Massachusetts General Hospital

Eleftherios Mylonakis, MD is a member of the following medical societies: American Association for the Advancement of Science, American College of Physicians, American Society for Microbiology, and Infectious Diseases Society of America

Disclosure: Nothing to disclose.

Chief Editor

Burke A Cunha, MD  Professor of Medicine, State University of New York School of Medicine at Stony Brook; Chief, Infectious Disease Division, Winthrop-University Hospital

Burke A Cunha, MD is a member of the following medical societies: American College of Chest Physicians, American College of Physicians, and Infectious Diseases Society of America

Disclosure: Nothing to disclose.

References

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