Synopsis
Recognise post-streptococcal inflammatory disease, prevent recurrence and manage chronic valve damage in a UK pathway.
- Acute rheumatic fever (ARF) is an immune-mediated complication usually appearing 1-5 weeks after group A streptococcal throat or skin infection.
- Use revised Jones criteria plus evidence of preceding streptococcal infection; polyarthritis, carditis, chorea, erythema marginatum and subcutaneous nodules are the classic major manifestations.
- Echocardiography with Doppler is required in suspected or confirmed ARF even when auscultation is normal because carditis may be subclinical.
- Sydenham chorea and indolent carditis can present late, when streptococcal tests have normalised; do not reject the diagnosis solely for a negative ASO titre.
- Eradicate residual streptococcus and start secondary prophylaxis after ARF; benzathine benzylpenicillin 1.2 million units IM every 3-4 weeks is the licensed adult regimen.
- Prophylaxis duration is longer with carditis: at least 5 years/up to age 21 without cardiac involvement, at least 10 years/up to age 21 after transient carditis, and at least 10 years/up to age 40 with persistent involvement; some need lifelong prophylaxis.
- Chronic rheumatic heart disease most often produces mitral stenosis/regurgitation, frequently with multivalve disease; assess AF, pulmonary pressure and pregnancy risk.
- Antibiotic prophylaxis against infective endocarditis is not routinely offered for dental procedures solely because of rheumatic valve disease under NICE CG64.