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Rheumatic Fever

Definition


Disease: Rheumatic Fever Rheumatic Fever
Category: Bones, joints, muscles diseases
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Disease Definition:

The inflammatory disease that can develop as a complication of untreated or poorly treated strep throat is called rheumatic fever. The infection with group A streptococcus bacteria is the cause of strep throat.

Though it can develop in younger children and adults, rheumatic fever is most common in 5- to 15- year old children. People between the ages of 25 to 35, are most affected by recurring episodes of rheumatic fever.

Rheumatic fever is still common in many developing nations. Serious harm to the heart valves and a heart failure may be the result of rheumatic fever which can cause permanent damage to the heart. The recurrence of rheumatic fever may be prevented, the pain and other symptoms may be lessened and the tissue damage from the inflammation may be reduced by treatment.

Work Group:


Prepared by: Scientific Section

Symptoms, Causes

Symptoms:

Rheumatic fever symptoms may vary. Some people may have several symptoms, while others experience only a few. During the course of the disease, symptoms may also be changed. About two to four weeks after a strep throat infection is when the onset of rheumatic fever usually occurs.

The signs and symptoms that result from inflammation in the central nervous system, skin, joints or heart may include:

 

  • Chest pain
  • Red, hot or swollen joints
  • Fever
  • Outbursts of unusual behavior, such as crying or inappropriate laughing, that accompanies Sydenham chorea
  • Sensation of rapid, fluttering or pounding heartbeats (palpitations)
  • Flat or slightly raised, painless rash with a ragged edge (erythema marginatum)
  • Painful and tender joints, most often the ankles, knees, elbows or wrists; less often the shoulders, hips, hands and feet
  • Shortness of breath
  • Small, painless nodules beneath the skin
  • Pain in one joint that migrates to another joint
  • Jerky, uncontrollable body movements (Sydenham chorea or St. Vitus' dance), which occurs most often in the hands, feet and face; less often in the arms and legs
  • Fatigue


If a child has signs or symptoms of strep throat, he/she should see a doctor. Rheumatic fever can be prevented by proper treatment of strep. Parents should call the doctor if their child has any of the following signs or symptoms:

 

  • Thick or bloody discharge from the nose, which is more likely in children under the age of 3
  • Rash
  • A sore throat accompanied by tender, swollen lymph glands (nodes)
  • Difficulty swallowing anything, including saliva
  • A sore throat without cold symptoms, such as a runny nose


While children who have strep throat and are over the age of 3 are likely to have a fever of 102 F (38.9 C) or higher, children younger than 3 who have strep throat often have a low fever. Parents should call the doctor about a fever in the following situations:

 

  • Infants under 3 months with a temperature of 38 C (100.4 F) or higher
  • Infants 3 to 6 months with a temperature of 38.3 C (101 F)or higher
  • Children 6 months to 2 years with a temperature of 39.4 C (103 F) or higher
  • Children 6 months or older with a temperature of 38.9 (102 F) if the temperature continues to rise or lasts more than three days.


Additionally, if the child shows any other signs or symptoms of rheumatic fever, a doctor should be consulted.

Causes:

After an infection of the throat with a bacterium called Streptococcus pyogenes, or group A streptococcus, rheumatic fever may occur. Strep throat or, less commonly, scarlet fever is caused by group A streptococcus infections of the throat. Rheumatic fever is rarely triggered by group A streptococcus infections of the skin or other parts of the body.
It appears that the bacterium "plays tricks" on the immune system, but the exact link between strep infection and rheumatic fever isn't clear. The strep bacterium contains a protein similar to one found in certain tissues of the body. That's why the immune system cells that would normally target the bacterium may target the body's own tissues as if they were infectious agents, particularly tissues of the central nervous system, skin, joints and heart. Inflammation is the result of the immune system’s reaction.
There's a little to no chance of developing rheumatic fever if the child receives prompt and complete treatment with an antibiotic to eliminate strep bacteria, which means taking all doses of the medication as prescribed. The child may, but not necessarily, develop rheumatic fever if he/she has one or more episodes of strep throat or scarlet fever that aren't treated completely or aren’t treated at all.

The risk of rheumatic fever may increase due to factors such as:

Environmental Factors: A greater risk of rheumatic fever is associated with overcrowding, poor sanitation and other conditions that may easily result in the rapid transmission or multiple exposures to strep bacteria.
Family History: Some people may carry a gene or genes that make them more susceptible to developing rheumatic fever.
Type of Strep Bacteria: Certain strains of strep bacteria are more likely to contribute to rheumatic fever than are others.

Complications

Complications:

The inflammation that is caused by rheumatic fever may last for a few weeks to several months. Long-term complications may sometimes result from the inflammation.
The permanent damage to the heart caused by the inflammation of rheumatic fever is called rheumatic heart disease. The valve between the two left chambers of the heart (mitral valve) is the most commonly affected one with problems; but these problems could also affect the other valves. One of the following conditions may be the result of the damage:

Damage to heart muscle from inflammation may weaken the heart muscle, resulting in poor pumping function.
Valve regurgitation is a leak that allows blood to flow in the wrong direction.
Valve stenosis is a narrowing of the valve resulting in decreased blood flow.

Damage to the mitral valve other heart valves or other heart tissues can cause problems with the heart later in life. It may result in one of these conditions:

Heart failure: This condition is the inability of the heart to pump enough blood to the body
Atrial fibrillation: This is an irregular and chaotic beating of the upper chambers of the heart (atria)

Treatments:

What treatment of rheumatic fever aims at is to prevent recurring episodes of rheumatic fever, relieve symptoms, destroy any remaining group A streptococcal bacteria and control inflammation.

ANTIBIOTICS:
To eliminate any remaining strep bacteria that may exist in the child's body, he/she will be prescribed penicillin or another antibiotic.
The doctor will begin another course of antibiotics to prevent recurrence of rheumatic fever, after the child has completed the full antibiotic treatment. This preventive treatment usually continues until the child is at least 20 years old. However, in case an older teenager has had rheumatic fever, he/she will have to complete a minimum five-year course of preventive treatment, which means that he/she may have to continue taking the antibiotics past the age of 20.
Taking the preventive antibiotic treatment much longer or even for life may be advised for people who experienced inflammation of the heart when they had rheumatic fever.

ANTI-INFLAMMATORY TREATMENT:  
To reduce inflammation, fever and pain, an anti-inflammatory drug, such as acetylsalicylic acid or naproxen may be prescribed. A corticosteroid, such as prednisone may also be prescribed if symptoms are severe or the child isn't responding to the anti-inflammatory drugs.

ANTICONVULSANT MEDICATIONS:
An anticonvulsant medication, such as carbamazepine or valproic acid may be prescribed if the involuntary movements of Sydenham chorea are severe.

LONG TERM CARE:
What type of follow-up and long term care the child will need should be discussed with the doctor. After the acute illness, heart damage from rheumatic fever may not show up until many years after. The child should be informed that he/she had rheumatic fever. When an adult, he/she should discuss this with a doctor.

Prognosis:

Not Available

Expert's opinion

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