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Rheumatic fever

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Rheumatic fever is most common in children between 4 – to 15- year old and is caused when a streptococcal throat infection has been inefficiently treated. An autoimmune disease, which means the body’s immune system attacks its own cell, the throat infection happens due to group A streptococcus bacteria.

If untreated or delayed treatment, rheumatic fever can cause permanent damage to the heart, which includes damaging heart valves and causing heart failure. A study conducted by AIIMS in and around Delhi to see prevalence of rheumatic heart disease (RHD) - a chronic heart condition caused by rheumatic fever -- among children in northern India has found prevalence of 20.4/1000 school children to be affected.

Symptoms of rheumatic fever

The symptoms for rheumatic fever are different for people and it is common for one person to show several symptoms. The symptom of a rheumatic fever may sometimes be confused with normal viral infection and hence may take time to diagnose. While a person may show numerous signs and symptoms described by the Jones criteria, typical symptoms, however, are following:

  • Fever
  • Painful joints
  • Red, hot or swollen joints
  • Small, painless nodules beneath the skin
  • Chest pain
  • Palpitations
  • Fatigue
  • Shortness of breath
  • Flat or slightly raised, painless rash
  • Unusual behavior

Causes of rheumatic fever

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The primary cause of rheumatic fever is the same bacterium that causes streptococcal throat infections or scarlet fever. Rheumatic fever is not contagious but the throat infection is. Rheumatic fever occurs after an infection of the throat with a bacterium called Streptococcus pyogenes, or group A streptococcus.

The exact correlation between the throat infection and rheumatic fever is not known nor is the reason behind the body’s immune system attacking its own tissues. If a person gets proper antibiotic treatment for his strep throat, there are minimal chances of him developing rheumatic fever.

Risk Factors of rheumatic fever

While chances of getting rheumatic fever is low if proper medication is provided during the onset of strep throat, risk increases when certain factors are considered:

Development – Rheumatic fever is generally high in underdeveloped countries and most of western world hardly sees any such cases.  There is a greater risk of bacterial infection in places which are overcrowded and have poor sanitation.

Family history – It is seen people sometimes have a gene which is more prone to developing rheumatic fever.

Diagnosis of rheumatic fever

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Some signs of rheumatic fever are very easy to be diagnosed by an experienced doctor.

A physical examination by a doctor along with signs of inflammation is often enough for a doctor to determine rheumatic fever. A doctor may check the joints for signs of inflammation, look around your body for nodules or rash and may call for further tests if he suspects rheumatic fever.

Blood test – This is the foremost test that is done to determine the presence of strep bacteria. If a patient already suffers from a strep throat, a blood test will quickly and convincingly prove the danger of a rheumatic fever.

Electrocardiogram (ECG) - An electrocardiogram — also called an ECG or EKG — is a device used to measure electrical signals of a heart. If a patient has strep infections heart signals will be weak of erratic.

Echocardiography  - An echocardiogram can also be recommended by a doctor if the rheumatic fever is in its advance stages. The sound waves produced during echocardiography helps determine any damage to the heart valves.

Treatment of rheumatic fever

Till penicillin was discovered, rheumatic fever was an untreatable disease. Today, however, this disease is easily treatable and if detected early modern medicines can effectively destroy group A streptococcal bacteria, relieve symptoms and also prevent recurrence.

Antibiotics – Antibiotics are the foremost in the line of treatment. Antibiotics in the form of intramuscular penicillin G benzathine, oral penicillin V potassium, and oral amoxicillin are the recommended antimicrobial agents for the treatment of rheumatic fever. Penicillin alone has been documented as a very effective medicine for strep infection and has almost always been able to deal with rheumatic fever. Patients are no longer considered contagious after 24 hours of antibiotic therapy.

Generally a full course of penicillin is recommended to take care of any residual infection and prevent its recurrence.

Anti-inflammatory treatment – To take care of your inflation and pain in joints, pain relievers can also be administered. Drugs that contain aspirin are the first line of medicines to be given and once the disease is conformed naproxen may be administered.

Anticonvulsant medications – If there are signs of Chorea (involuntary movements) doctors may also prescribe an anticonvulsant such as valproic acid or carbamazepine.

If a child catches rheumatic fever he or she may need long term care. It is best to discuss with a doctor on the roadmap for follow ups and the care a child may need.

Complications of rheumatic fever

Once treated rheumatic fever causes no damage to the body but there can be complications for few patients. In cases where the infection was intense the biggest complications are cardiac in nature. Patients with rheumatic fever who develop carditis may develop long-lasting heart dysfunction. Sometimes a surgery may also be needed in cases where the valve of the heart needs replacement. Some are very susceptible to the bacteria and may require lifetime antibiotic treatment.

Prevention of rheumatic fever

There is no known prevention for the disease. Whenever a case of strep throat comes to light it should be immediately and comprehensively treated.

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Written by: Saptakee sengupta
Date last updated: April 17, 2015