[Diagnosis and treatment of rheumatic fever]

Rheumatic fever has become rare in France as in most developed countries. However, recent outbreaks have underlined the need for practitioners to remain vigilant and to maintain careful prevention. Polyarthritis and polyarthralgia are the main manifestations of rheumatic fever but they are not specific. Carditis is a major feature which affects only half the patients; cardiac ultrasonography is therefore very helpful with respect to positive and false positive diagnoses resulting from innocent murmurs. Fever, acute phase inflammatory markers, and evidence of streptococcal infection are of major importance and rheumatic fever must be disregarded in their absence. The treatment includes: 1) steroids for a 3 month-period; 2) early antibiotic treatment of streptococcal carriage; 3) long-term prophylaxis using intramuscular benzathine penicillin.