Summary
Definition
History and exam
Other diagnostic factors
- recent sore throat or scarlet fever
- recent skin infection
- chest pain
- shortness of breath
- palpitations
- heart murmur
- pericardial rub
- signs of cardiac failure
- swollen joints
- restlessness
- clumsiness
- emotional lability and personality changes
- jerky, uncoordinated choreiform movements
- inability to maintain protrusion of the tongue
- milkmaid's grip
- spooning sign
- pronator sign
- erythema marginatum
- subcutaneous nodules
- pregnancy or taking oral contraceptive pill
Risk factors
- poverty
- overcrowded living quarters
- family history of rheumatic fever
- HLA association
- genetic susceptibility
- indigenous populations; Aboriginal Australian, Asian, and Pacific Islanders
- D8/17 B cell antigen positivity
Diagnostic investigations
1st investigations to order
- erythrocyte sedimentation rate (ESR)
- CRP
- WBC count
- blood cultures
- electrocardiogram
- chest x-ray
- echocardiogram
- throat culture
- rapid antigen test for group A streptococci
- anti-streptococcal serology
- rapid molecular test
Treatment algorithm
Contributors
Authors
Liesl Zühlke, MBChB DCH FCPaeds Cert Card (Paeds) MPH FACC FESC MSc PhD
Vice-President South African Medical Research Council - Extramural Research and Internal Portfolio
Director Children's Heart Disease Research Unit
Paediatric Cardiologist, Division of Paediatric Cardiology, Department of Paediatrics
Red Cross Children's Hospital
Cape Heart Institute and Institute of Infectious Diseases and Molecular Medicine
Faculty of Health Sciences
University of Cape Town
Cape Town
South Africa
Disclosures
LZ has been funded by the South African Medical Research Council, NRF, and through the African Research Leader award jointly by the UK Medical Research Council (MRC) and the UK Department for International Development (DFID) under the MRC/DFID Concordat agreement. LZ is a board member of the World Heart Federation, the NCD Alliance, and FoodForward South Africa. LZ an author of the UpToDate rheumatic heart disease topic. None of the above are competing interests.
John Lawrenson, null
Head of Clinical Unit
Paediatric Cardiology Service of the Western Cape
Red Cross Children's and Tygerberg Hospital
Stellenbosch University and University of Cape Town
Cape Town
South Africa
Disclosures
JL declares that he has no competing interests.
Acknowledgements
Professor Liesl Zühlke and Professor John Lawrenson would like to gratefully acknowledge Dr Rachel Webb, Dr Andrew C. Steer, and Dr Jonathan Carapetis, previous contributors to this topic.
Disclosures
RW declares that she has no competing interests; she is an active researcher and clinician in acute rheumatic fever/rheumatic heart disease and is a co-investigator on a (non-industry) grant funded by the Health Research Council of New Zealand and gives educational talks and has prepared manuscripts on rheumatic fever solely in capacity as a University of Auckland academic and Paediatric Infectious Diseases Specialist. ACS and JC declare that they have no competing interests.
Peer reviewers
Salah Zaher, MD
Professor of Pediatrics
Division of Pediatric Cardiology
Faculty of Medicine
University of Alexandria
Cardiologist
El Shatby Children's Hospital
Alexandria
Egypt
Disclosures
SZ declares that she has no competing interests.
Nigel Wilson, FRACP
Paediatric Cardiologist/Interventional Cardiologist
Paediatric and Congenital Cardiac Services
Green Lane Clinical Services
Starship Children's Hospital
Auckland
New Zealand
Disclosures
NW declares that he has no competing interests.
Andrea Summer, MD
Assistant Professor of Pediatrics
Medical University of South Carolina
Charleston
SC
Disclosures
AS declares that she has no competing interests.
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