Rheumatic Fever Follow-up
- Author: Mark R Wallace, MD, FACP, FIDSA; Chief Editor: Michael Stuart Bronze, MD more...
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).
Compliance with long-term secondary antibiotic prophylaxis is often poor, and close follow-up is mandatory.
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.
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.
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.
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.
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.
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, 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.
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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