In other cases, symptoms go unrecognised. These usually follow one to five weeks after the sore throat – if there is one. They can disappear by themselves but should always be thoroughly checked by a doctor.
The first is sore joints. Whangarei paediatrician Roger Tuck explains that parents sometimes assume their child has banged their leg or worn themselves out at rugby. But the pain caused by rheumatic fever has a habit of ghosting around the body, jumping suddenly from ankle to wrist, for example. Hence “licks the joints”.
It is an exquisite arthritis, Tuck emphasises, one of the most painful forms you can get. Young people with it often can’t walk; they’re in agony. Tip: an aspirin often wipes out this pain completely. Take that as a warning sign, not a solution.
Fever is common during a bout of acute rheumatic fever and some people get lumps under the skin or a rash called erythema marginatum.
The haywire immune system often gives the brain a lick too – specifically, in the basal ganglia. That can result in a movement disorder, called chorea, that can be so severe the person can’t stand.
“All sorts of funny movements, just gesticulating and strange grimacing. People think, ‘Oh, this child is on drugs.’” Often the child will sit on their hands, Tuck says.
They can also have severe mood disturbances. “I’ve seen kids who have been going for several months before the GP’s phoned me and said, ‘I’m not sure whether to send this child to a psychiatrist – you have a look first.’ Within 30 seconds, I’ll say this is chorea. This child has had rheumatic fever. Then we’ll do an echo [cardiogram] and find the kid’s got a [damaged heart] valve.”
Everything else is temporary. The major concern is always the heart. “If the heart’s healthy, we say [to parents], ‘Thank God, the heart’s okay. But what this does mean is that your child must never ever have rheumatic fever, ever again.”
This article was first published in the July 29, 2017 issue of the New Zealand Listener.