Rheumatic Fever and Rheumatic Heart Disease

Abstract

Rheumatic Heart disease is the second most common cause, after Kawasaki disease, of acquired heart diseases in children. Rheumatic fever is precipitated by GAS pharyngitis and not other types of GAS infections. Pharyngitis with GAS causes T-cell and B-cell lymphocytes to produce antibodies presumably against some antigenic component of the bacteria that cross-react with an antigen on myocytes or cardiac valve tissue. Diagnosis is made when there is history of GAS pharyngitis and presence of Jones criteria. Two major criteria, or one major criterion and two minor criteria are required to make the diagnosis. Major criteria of Jones are: carditis, polyarthritis, chorea, erythema marginatum, and subcutaneous nodules. Minor criteria of Jones are: fever, polyarthralgia, elevated ESR, ECG findings (prolonged PR interval), elevated ASO titer, positive throat culture of group A beta hemolytic streptococci, positive rapid antigen test for group A streptococci and recent scarlet fever. Treatment includes eradication of any residual GAS bacteria and the use of anti-inflammatory agents (aspirin with or without steroids). Long-term prophylaxis with antibiotics is done to prevent recurrence.