<Tr> <Th> Deaths </Th> <Td> 319,400 (2015) </Td> </Tr> <P> Rheumatic fever (RF) is an inflammatory disease that can involve the heart, joints, skin, and brain . The disease typically develops two to four weeks after a streptococcal throat infection . Signs and symptoms include fever, multiple painful joints, involuntary muscle movements, and occasionally a characteristic non-itchy rash known as erythema marginatum . The heart is involved in about half of cases . Damage to the heart valves, known as rheumatic heart disease (RHD), usually occurs after repeated attacks but can sometimes occur after one . The damaged valves may result in heart failure, atrial fibrillation and infection of the valves . </P> <P> Rheumatic fever may occur following an infection of the throat by the bacterium Streptococcus pyogenes . If the infection is untreated rheumatic fever can occur in up to three percent of people . The underlying mechanism is believed to involve the production of antibodies against a person's own tissues . Due to their genetics, some people are more likely to get the disease when exposed to the bacteria than others . Other risk factors include malnutrition and poverty . Diagnosis of RF is often based on the presence of signs and symptoms in combination with evidence of a recent streptococcal infection . </P> <P> Treating people who have strep throat with antibiotics, such as penicillin, decreases the risk of developing rheumatic fever . In order to avoid antibiotic misuse this often involves testing people with sore throats for the infection, which may not be available in the developing world . Other preventive measures include improved sanitation . In those with rheumatic fever and rheumatic heart disease, prolonged periods of antibiotics are sometimes recommended . Gradual return to normal activities may occur following an attack . Once RHD develops, treatment is more difficult . Occasionally valve replacement surgery or valve repair is required . Otherwise complications are treated as per normal . </P>

The risk factors for rheumatic fever include age and infection with