How to Diagnose Rheumatic Fever

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1Diagnosing Strep Throat

2Watching for Rheumatic Fever

3Treating Rheumatic Fever

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If your child was exposed to strep throat, it is possible they can develop rheumatic fever if the disease is left untreated. However, keep in mind that rheumatic fever is extremely rare in developed countries. It most commonly affects children ages 5 to 15. It's important to diagnose strep throat early and treat it with antibiotics. You can take your child to the doctor as soon as you notice symptoms and get tested to rule out other common illnesses causing your symptoms. If you see signs of rheumatic fever, it's even more important to get them to the doctor.

Steps

Part 1

Part 1 of 3:

Diagnosing Strep Throat

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   Watch for the symptoms of strep throat. The primary symptom of strep throat is a sore throat, particularly when swallowing. The sore throat often comes on suddenly. Your child may also develop a fever of 101 to 104 °F (38 to 40 °C), a headache, or stomach pains.

   • Rheumatic fever can take 1–5 weeks after untreated strep throat to develop.
   • While it's rare to develop rheumatic fever from strep throat, it can happen. That said, it may be difficult for your doctor to diagnose rheumatic fever in its early stages.
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   Visit the doctor. If you suspect your child has strep throat, you must visit the doctor to find out. The only sure way to know is to do a strep test, which your doctor can perform.

   • Sore throats are generally a symptom of sickness, so if your child has a sore throat, you probably want to get them seen by a doctor.
   • Tell your doctor if your child is exhibiting other symptoms of strep, such as fever, swollen tonsils, rash, nausea or vomiting, and body aches.
   • Your doctor might run a quick test for the flu or mononucleosis since they have similar symptoms as strep.
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   Expect a rapid antigen test first if your doctor suspects rheumatic fever. This test can be done quickly in the office. The doctor will lightly run a cotton swab over your child's throat. The test checks for antigens that indicate strep. If your child is on antibiotics, however, this test can come back negative even if your child has strep. Your doctor will likely do a second test in this case.
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   Ask about a throat culture. If the rapid antigen test comes back negative, ask if the doctor can do a throat culture, which is a more accurate test. In this case, the doctor swabs the back of your child's throat and their tonsils, which may cause a little gagging. Then the sample is sent to the lab. It may take up to 2 days to get the results.

   • While you wait for the throat culture results, your doctor may put your child on antibiotics just in case.
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   Look for scarlet fever. Scarlet fever can develop from strep throat. If it happens, your child may develop a sandpapery red rash, redness in the body's creases (armpits, elbows, etc.), and a white coating on the tongue or later, a strawberry-like tongue. Your child may also have swollen glands in their neck.

   • Talk to your doctor as soon as possible if you suspect your child has scarlet fever. The doctor will likely refer you to a dermatologist for testing. The dermatologist can determine if your child has scarlet fever or rheumatic fever.
   • Rheumatic fever can develop from scarlet fever. Both scarlet fever and rheumatic fever have similar symptoms, but rheumatic fever may have long-term effects. For this reason, it is important to have your child diagnosed by a doctor.
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Part 2

Part 2 of 3:

Watching for Rheumatic Fever

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   Look for the symptoms. The main symptoms of rheumatic fever are swollen; painful joints in your knees, ankles, elbows, and wrists; fever; fatigue; chest pain; accelerated heart rate; and shortness of breath. These symptoms develop when the antibodies the body produces to fight the bacteria start targeting healthy tissues, including the heart. It's normal to feel a little scared. Just try to stay calm, and get your child to the doctor as soon as you can.

   • Go to the doctor at the first sign of symptoms. If your child is having chest pains or shortness of breath, go to the emergency room.
   • Your child may also have a rash on their chest or abdomen, as well as bumps under the skin.
   • The most significant symptom of rheumatic fever is severe joint pain. In many cases, the child will be unable to walk. If this occurs, see a doctor immediately.
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   Expect a blood test. The strep bacteria may already be gone from your child's body. However, the antibodies will still be there, so that's what the blood test will check for. The doctor will also use the blood test to check for indicators for inflammation in the blood.

   • However, the doctor will still look for the bacteria in your child's blood.
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   Be ready for an electrocardiogram. This test measures the electrical signals that travel through your child's heart. The doctor uses this test to make sure your child's heart is working as it should be.

   • For this test, electrodes will be placed on your child's chest, arms, and legs. The electrodes are little sticky patches. The test doesn't hurt, though taking the patches off may hurt a bit.
   • If rheumatic fever is not treated in a timely manner, the child may develop heart complications. This condition is called sub-acute bacterial endocarditis (SABE). Your doctor will monitor your child throughout their treatment for these complications.
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   Prepare for an echocardiogram. This test is used to check for fluid around the heart, leaky valves, or a poorly working heart muscle. It's an ultrasound, so it's done in much the same way an ultrasound is done for a pregnant woman.

   • The technician will put gel on your child's chest, then they will run a probe over your child's chest. In some cases, your child may have an electrocardiogram combined with an echocardiogram, meaning your child will also have electrodes on their chest during this test.
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Part 3

Part 3 of 3:

Treating Rheumatic Fever

1. 
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   Expect long-term antibiotics. The first medication your doctor will likely prescribe is antibiotics. The antibiotics will help rid your child's system of the strep bacteria, which is what's causing the main problem. Typically, your child will have a standard round of antibiotics, and then be put on an antibiotic regimen to prevent recurrence.

   • In a number of cases, your child may be required to stay on antibiotics for up to 5 years or until they turn 21, whichever happens last. If they had heart inflammation, it's more likely to be 10 years or until they turn 25 to prevent a recurrence of the disease.
   • In some cases where severe heart inflammation occurred, the doctor may recommend a low-grade antibiotic while the person is undergoing dental work. In very severe cases, the person may be on antibiotics until they turn 45 or 50.
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   Discuss anti-inflammatories with the doctor. Anti-inflammatories are also a common treatment, particularly naproxen or aspirin. These drugs help relieve pain and decrease inflammation. If these don't work, your child may be put on a corticosteroid.

   • Though aspirin usually isn't recommended for kids under 16, doctors make an exception in the case of rheumatic fever. Your child will likely only need to be on a low dose for 2 weeks, and it can help with the inflammation.
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   Ask advice about anticonvulsant medications. In some cases, your child may develop involuntary movements, a condition known as Sydenham chorea. In that case, an anticonvulsant may be appropriate. Common medications for this condition include carbamazepine.
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   Keep your child in bed. Your child will need lots of rest to recover from this condition. Staying in bed helps with the tiredness and the trouble breathing. Plus, it may be able to keep them relaxed and reduce the chance of complications. As your child begins to feel better, they can gradually begin to up how much activity they do each day.
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