A patient had rheumatic fever as a child. What long-term sequelae should be anticipated?

Correct answer: B. Cardiac valvular damage and chronic joint problems

• A. Hearing loss is not a feature of rheumatic fever.
• B. CORRECT. Acute rheumatic fever is an autoimmune sequel to group A streptococcal PHARYNGITIS, in which antibodies to streptococcal M protein cross-react with host tissue. The lasting consequence is RHEUMATIC HEART DISEASE — valvular scarring, most often of the MITRAL valve, then the aortic — together with the migratory polyarthritis and, in some patients, chronic joint symptoms.
• C. Rheumatic fever is bacterial and immunologically mediated; it has no relationship to herpes simplex.
• D. Post-streptococcal GLOMERULONEPHRITIS is a different, separate sequel of streptococcal infection (more often skin infection) and usually resolves; it is not the classic long-term consequence of rheumatic fever.

Note: The dental relevance: under current AHA guidance, a history of rheumatic fever ALONE is NOT an indication for antibiotic prophylaxis. Prophylaxis is indicated only for prosthetic valves or prosthetic repair material, previous infective endocarditis, specified congenital heart disease, and cardiac transplant recipients with valvulopathy. Rheumatic valve disease that has led to valve REPLACEMENT does qualify — by virtue of the prosthesis.