Rheumatic fever does not present with specific signs and symptoms. There is sudden onset of fever, joint pain, malaise and loss of appetite. In some cases, epistaxis and abdominal pain may also be present.
The diagnosis is made with the help of Duckett Jones criteria . The presence of two major criteria; or one major and two minor criteria is diagnostic.
The major criteria include the following:
The minor criteria include the following:
The diagnosis of rheumatic fever is usually clinical. The following investigations may be helpful.
The treatment of rheumatic fever has the following components  .
Bed rest: The patient should be advised complete bed rest until the temperature, resting pulse, erythrocyte sedimentation rate (ESR) and electrocardiogram (ECG) return to normal.
Aspirin: Aspirin and other salicylates are very effective in reducing the fever and relieving joint pain and swelling in the patients suffering from rheumatic fever. Aspirin therapy is continued for a period of 2 weeks. If the polyarthritis is controlled by then, the dosage is tapered for an additional 6 weeks. This is necessary because sudden discontinuation of aspirin therapy can cause recurrence of symptoms.
Corticosteroids: If the response to aspirin therapy is inadequate or if there is severe arthritis or carditis, a short course of steroids is given for 2 weeks after which the dosage is tapered over a period of 3 weeks.
During the initial phase, symptoms may last for several months in children and several weeks in adults. The mortality rate in this phase is 1 to 2%.
Valve disease occurs in up to two thirds of the patients by 10 years; however, not all the patients will develop symptoms or cardiomegaly.
Rheumatic fever usually follows a pharyngeal infection caused by beta-hemolytic streptococcal species after a latent period of approximately 3 weeks. It results from the cross-reaction of the body’s immune response to the streptococcal antigen with its own tissues - principally those of the heart  .
Rheumatic fever is much more prevalent in the developing countries where the incidence is as high as 1 case per 1000 population. In the developed countries, factors such as improved hygiene and living conditions, decreased crowding, the use of antibiotics and proper treatment have greatly reduced the incidence of rheumatic fever  .
Rheumatic fever commonly occurs in children aged 5 to 15 years - the peak age being 8 years. It is rare before the age of 4 and occasional cases are seen after the age of 30.
The acute phase of rheumatic fever is characterized by exudative and proliferative inflammatory reactions involving the heart, joints, brain, skin and subcutaneous tissues.
Rheumatic carditis principally involves the mitral (75-80%) and aortic (30%) valves. The valve cusps become thickened by edema and by infiltration of capillaries. Later on, a row of vegetations forms along the lines of closure of the valve leaflets. Inflammation of the valves leads to mitral and aortic regurgitation. In addition to valvulitis, there may be myocarditis and pericarditis.
Primary prevention: The development of rheumatic fever can be stopped if there is prompt recognition and proper treatment for group A streptococcal pharyngitis and tonsillitis. Intramuscular benzathine penicillin is the antimicrobial agent of choice. In the patients allergic to penicillin, erythromycin or azithromycin may be used .
Secondary prevention: The recurrence of rheumatic fever can be prevented by continuous antimicrobial prophylaxis. An injection of benzathine penicillin should be given every 4 weeks. Salphasalazine or erythromycin are given in the patients who can not tolerate penicillin .
Rheumatic fever is an acute inflammatory disease that follows infection with group A beta-hemolytic streptococci. It is characterized by inflammatory lesions of connective tissue, mainly the heart, blood vessels and joints.
Rheumatic fever occurs as a delayed sequela of throat infection with certain species of bacteria. It occurs much more commonly in children as compared to adults. The disease affects many parts of the body, in particular the heart and the joints. If the throat infection with the causal bacteria is detected and treated early, rheumatic fever can be prevented. The treatment of rheumatic fever is mostly symptomatic. Antibiotics are used to prevent the disease from occurring after it has been successfully controlled.