rheumatic fever

Rheumatic fever can affect children who have had a group A strep infection in the throat, causing problems with their skin, nervous system, joints, or heart.

Rheumatic fever (FR) is an inflammatory disease that can affect multiple organ systems of the body (multisystem): skin, heart, nervous system, joints, neurologic, immune system, producing numerous and varied symptoms. Although fortunately rare in children, it can occur between the ages of five and adolescence.

Although its cause is not entirely clarified, it is thought that its origin is related to the infection in the throat, a few weeks before the onset of the picture, by a germ called group A streptococcus, which causes infection of the tonsils ( tonsillitis ).

Although streptococcal tonsillitis is a trivial process and responds well to antibiotics such as penicillin or amoxicillin, in some individuals, it leads to an immune reaction and, during acute infection, some components of the germ are released into the blood that they are very similar to human tissues, thus initiating an autoimmune process in which autoantibodies are generated.

As their name suggests, these autoantibodies affect our body’s own tissues and target cells of the heart, skin, subcutaneous cellular tissue, joints, nervous system.

Although it is a rare disease in developed countries, rheumatic fever is still common in many countries with low economic resources and insufficient health care to which the entire population does not have access. The severity of this pathology depends on the possible cardiac involvement and its sequelae, so it is important to properly treat respiratory infections caused by group A streptococcus, especially in children.

Rheumatic fever prognosis

The main factor that marks the prognosis of rheumatic fever in children is cardiac involvement; the more severe the heart damage, the more likely it is to persist for life.

The main preventive measure for this disease is to properly treat streptococcal tonsillitis, completing the course of antibiotics every day as indicated by the pediatrician.

The symptoms of rheumatic fever in children are derived from the involvement of multiple organs and systems against which autoantibodies are created. The first symptoms usually appear two to four weeks after a strep throat.

Tonsillitis initially characterized by fever high (over 39C), red tonsils appearance of exudates (pus), swollen glands in the neck, abdominal pain, and sometimes, a red rash on the skin, rough to the touch, which is known as scarlet fever.

Between 2-3 weeks after this tonsillitis, symptoms of rheumatic fever may appear in children derived from the involvement of the different organs:


Intermittent fever and joint pain are the most common early symptoms of rheumatic fever. Pain and inflammation appear in the knees, ankles, elbows, wrists, and less frequently, hips and shoulders, or smaller joints such as those of the fingers, can also be affected. This pain characteristically moves from one joint to another (migratory arthritis) and usually lasts two to four weeks.


Over the weeks, there is an inflammation of the layer that surrounds the heart (pericardium), and the heart valves also become inflamed, especially the one that separates the left atrium and left ventricle (mitral valve). Damage to this valve produces a very distinctive heart murmur. Cardiac involvement occurs in 50-60% of cases.


A flat, wavy-edged rash appears that lasts for a short time (erythema marginate), and sometimes subcutaneous nodules may appear under the skin (only in 10% of cases).

Nervous system

A condition called chorea minor or Sydenham’s chorea may occur. It is considered a late manifestation affecting adolescent girls. It has coordinated movements, grimaces, irritability, clumsiness, and character disturbances. Fortunately, it is present in only 2% of cases of rheumatic fever in minors.