Rheumatic fever natural history, complications, and prognosis

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Lance Christiansen, D.O.; Associate Editor(s)-in-Chief: Cafer Zorkun, M.D., Ph.D. [2]; Varun Kumar, M.B.B.S. [3]; Anthony Gallo, B.S. [4]


If left untreated, patients with rheumatic fever may progress to develop arrhythmias, systemic emboli, and endocarditis, which may lead to cardiac failure. Common complications of rheumatic fever include mitral/aortic valve stenosis, carditis, and stroke. Prognosis is generally poor if left untreated.

Natural History, Complications, and Prognosis

Natural History

If left untreated, rheumatic fever may cause valvular diseases including stenosis, regurgitation of mitral/aortic valves and myocarditis. This may lead to decreased cardiac output, pulmonary edema, and ultimately cardiac failure. If an individual develops rheumatic fever, they will develop an increased sensitization to Streptococcus pyogenes autoantigens. Future infection will likely cause an elevated, autoimmunological response and a more severe case of rheumatic fever will develop.

It is estimated that the recurrence rate of rheumatic fever is decreased by about 85% by providing prophylactic penicillin therapy. Recurrence rate of 0.2/patient/year follow-up was noted among those not receiving regular treatment.[1]


Complications to rheumatic fever include:[1][2][3]


For cases without carditis, the prognosis is excellent, demonstrating no residual heart disease. In cases with preexisting or developing heart disease, the prognosis is poor, leading to mortality.[4]


  1. 1.0 1.1 Majeed HA, Yousof AM, Khuffash FA, Yusuf AR, Farwana S, Khan N (1986). "The natural history of acute rheumatic fever in Kuwait: a prospective six year follow-up report". J Chronic Dis. 39 (5): 361–9. PMID 3700577.
  2. Garg N, Kandpal B, Garg N, Tewari S, Kapoor A, Goel P; et al. (2005). "Characteristics of infective endocarditis in a developing country-clinical profile and outcome in 192 Indian patients, 1992-2001". Int J Cardiol. 98 (2): 253–60. doi:10.1016/j.ijcard.2003.10.043. PMID 15686775.
  3. Carapetis JR, Steer AC, Mulholland EK, Weber M (2005). "The global burden of group A streptococcal diseases". Lancet Infect Dis. 5 (11): 685–94. doi:10.1016/S1473-3099(05)70267-X. PMID 16253886.
  4. The Natural History of Rheumatic Fever and Rheumatic Heart Disease, Rheumatic Fever Working Party of the Medical Research Council of Great Britain and the American Heart Association (1965). http://circ.ahajournals.org/content/32/3/457 Accessed on October 12, 2015