​Acute rheumatic fever is a complication of a bacterial throat infection. Episodes of acute rheumatic fever can cause permanent damage to the heart valves, which is known as rheumatic heart disease. People with acute rheumatic fever and rheumatic heart disease need long-term treatment to prevent repeat episodes of acute rheumatic fever that may cause further damage to the heart.

Last updated: 01 October 2015
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​What is Acute Rheumatic Fever?

Acute rheumatic fever is an illness that can affect many parts of the body including the heart, joints, brain and skin. It can occur after a throat infection caused by bacteria called group A Streptococcus.

What is Rheumatic Heart Disease?

When acute rheumatic fever involves the heart, it can cause damage to the heart valves and this is called rheumatic heart disease.

Why are they important?

Acute rheumatic fever and rheumatic heart disease can lead to major long term heart problems, especially if not identified and treated correctly. There are simple and effective treatments available, especially if these conditions are found and treated early.

What are the symptoms of acute rheumatic fever?

People with acute rheumatic fever may complain of one or more of the following:

  • Fever (high temperatures)
  • A non-itchy rash
  • Painless skin lumps
  • Swollen, red or painful joints
  • Abnormal body movements or twitches (chorea)
  • Weakness
  • Tiredness
  • Chest pain
  • Shortness of breath
  • Rapid heartbeat

Symptoms of acute rheumatic fever may follow a sore throat. Sometimes the doctor may hear a ‘heart murmur’ when he/she listens with a stethoscope.

You should see your doctor if you have some of these symptoms.

Who is more likely to have acute rheumatic fever and rheumatic heart disease?

Children aged between 5 and 14 years are most commonly affected. Young adults are also at risk.

A person who has had one attack of acute rheumatic fever is more likely to have another attack.

Acute rheumatic fever occurs in people from all backgrounds, but higher rates of acute rheumatic fever and rheumatic heart disease occur in Aboriginal and Torres Strait Islander people, Maori and Pacific Islander peoples and some people born outside of Australia. Higher rates are also seen in women and in people living in disadvantaged conditions and where access to health services is poor.

Can acute rheumatic fever and rheumatic heart disease be prevented?

Yes, following an attack of acute rheumatic fever preventive treatment for group A Streptococcus infection is needed to stop further attacks of acute rheumatic fever and prevent further heart damage. Preventive treatment for group A Streptococcus infection involves antibiotic injections every 3-4 weeks. This treatment is recommended for a minimum of 10 years after the last episode of acute rheumatic fever. It is important for people to continue this treatment every 21-28 days until the doctor tells them to stop.

Prompt treatment of sore throat and skin sores in people at risk of acute rheumatic fever can also reduce the risk of an attack.

Acute rheumatic fever can also be prevented in communities by improving the conditions in which people live.

How is it diagnosed?

Currently, there is no single laboratory test for acute rheumatic fever. Diagnoses of acute rheumatic fever and rheumatic heart disease are based on clinical signs and symptoms.

Tests for acute rheumatic fever and rheumatic heart disease may include:

  • Review of your medical history
  • Physical examination
  • Throat swabs to test for the presence of group A Streptococcus bacteria
  • Blood tests to look for streptococcal antibodies and ‘markers’ that suggest inflammation is present
  • An echocardiogram to look at the valves in the heart
  • Electrocardiogram (ECG) to monitor the electrical activity of the heart
  • Chest x-rays to look at the heart for signs of inflammation and/or enlargement.

How is it treated?

Acute rheumatic fever can be treated with medication to relieve the discomfort associated with joint swelling and fevers. For patients with rheumatic heart disease, the main aim of treatment is to prevent further complications of heart disease. In severe cases, heart surgery may be required.

In addition to antibiotic treatment, people with acute rheumatic fever and rheumatic heart disease will need:

  • Regular check-ups with their doctor
  • Regular check-ups with a heart specialist to monitor their heart
  • Regular check-ups with their dentist to promote good oral health and reduce the risk of bacteria in their mouth entering the blood stream and causing inflammation or infection of the heart.
  • Vaccinations against influenza (‘flu’ vaccine) and pneumococcal infection.

Women with rheumatic heart disease need specialised prenatal care as pregnancy can make rheumatic heart disease worse.

How are we helping manage acute rheumatic fever and rheumatic heart disease in NSW?

NSW has introduced a register of people with acute rheumatic fever and rheumatic heart disease. This is to help people get the right treatment at the right time and to help identify communities which may need extra support for disease prevention.

For more information

For further information please call your local Public Health Unit on 1300 066 055.

Further information acute rheumatic fever and rheumatic heart disease can be found on the Rheumatic Heart Disease Australia website.

People with acute rheumatic fever or rheumatic heart disease should talk to their doctor about how to access services available in NSW.