Rheumatic fever is most common in children aged 5 to 15 years and usually develops approximately 20 days after a streptococcal throat infection like strep throat or scarlet fever. It is caused by certain strains of streptococcus bacteria. Symptoms may include a bright red rash, sore throat, fever, and inflammation of the joints, heart, and brain. If left untreated, rheumatic fever can damage the heart valves and cause long-term problems. Treatment involves antibiotics to treat the initial strep infection as well as medications and rest to reduce inflammation and prevent long-term damage.

2.  Most common in 5- to 15-year-old children
 Approximately 20 days after strep throat or scarlet fever

3. Causes
RF usually develop after infection with:
• Group A streptococcus infections of the throat
• Scarlet fever, less common
• Group A streptococcus infections of the skin or
other parts of the body rare

4. Scarlet fever
Bacterial infection that develops in some people who have
strep throat.
Clinical features
 Bright red rash covers most of the body,
 almost always accompanied by a sore throat and a high
fever.
Scarlet fever is most common in children 5 to 15 years of
age.
If left untreated, scarlet fever can result in more-serious
conditions that affect the heart, kidneys and other parts of
the body.

5. Risk factors
• Family history. Some people may carry a gene or
genes that make them more likely to develop
rheumatic fever.
• Type of strep bacteria. Certain strains of strep
bacteria
• Environmental factors :overcrowding, poverty

12. Clinical features
3- Sydenham chorea: 5-10%
A spasmodic non repetitive motion involving voluntary
muscles, occur when the patient is awake represent as a
Jerky, uncontrollable body movements, most often in
the hands, feet and face.
Unusual behavior, such as crying or inappropriate
laughing, that accompanies Sydenham chorea.

19. Diagnosis
Physical examination
• Check for fever
• Checkthe joints for signs of inflammation
• Examining the skin for nodules under the skin or a rash
• Listening to the heart for abnormal rhythms, murmurs
• Conducting a series of simple movement tests to detect CNS
inflammation

20. Investigations
• Throat swab
Cultured for streptococcus group A
• Serological test
Anti streptolycin O titer> 250 U
• Non specific indicators of inflammation
ESR and C- reactive protein elevated, leukocytosis
•Cardiac investigations
Electrocardiogram (ECG or EKG)
Echocardiography

25. • Antibiotics
 Patient with fever, active arthritis or active carditis
should be rested in bed.
Oral Penicillin: Phenoxypenicillin 500 mg 4 times daily for
one week
 preventive treatment
 Phenoxypenicillin 250 mg twice daily continues until the
child is at least 21 years old
 If past age 20 to complete a minimum five-year course
of preventive treatment.
 Patients with inflammation of the heart continue for the
rest of his life

26. • Anti-inflammatory treatment
Pain reliever, such as aspirin or naproxen
 For sever pain Corticosteroid, such as prednisone
60-120 mg in 4 time then tapered over 2-4 weeks.
 Anticonvulsant medications
Diazepam for Sydenham chorea

31. The damage may result in one of the following conditions
• Valve stenosis. This condition is a narrowing of the valve
, which results in decreased blood flow.
• Valve regurgitation. This condition is a leak in the valve,
which allows blood to flow in the wrong direction.
 Damage to heart muscle
 Atrial fibrillation, an irregular beating
Heart failure, an inability of the heart to pump
enough blood