Acute rheumatic fever, which occurs most often in school-age children, may develop after an episode of group A beta-hemolytic streptococcal pharyngitis (or “strep” throat). Patients with rheumatic fever may develop rheumatic heart disease as evidenced by a new heart murmur, cardiomegaly, pericarditis, and heart failure.

The Streptococcus is spread by direct contact with oral or respiratory secretions. Although the bacteria are the causative agents, malnutrition, overcrowding, poor hygiene, and lower socioeconomic status may predispose individuals to rheumatic fever. Incidence of rheumatic fever in the United States and other developed countries has generally decreased, but the exact incidence is difficult to determine because the infection may go unrecognized, and people may not seek treatment. Clinical diagnostic criteria are not standardized, and autopsies are not performed routinely.

Prevention of acute rheumatic fever is dependent on effective antibiotic treatment of streptococcal pharyngitis (see Pharyngitis, Acute in Section P). Antibiotic prophylaxis for recurrent rheumatic fever with rheumatic carditis may require 10 or more years of antibiotic coverage (e.g., penicillin G intramuscularly every 4 weeks, penicillin V orally twice daily, sulfadiazine orally daily, or erythromycin orally twice daily). Further information about rheumatic fever and rheumatic endocarditis can be found in pediatric nursing books.

For more information, see Chapter 28 in Hinkle, J. L., & Cheever, K. H. (2018). Brunner and Suddarth's textbook of medical-surgical nursing (14th ed.). Philadelphia, PA: Lippincott Williams & Wilkins.