Rheumatic Fever

Few years ago, many experts were making claims that rheumatic fever had virtually disappeared. Apparently it had; but subsequent outbreaks of rheumatic fever among children in several cities in the United States indicate that the disease has made a come back.

Rheumatic fever appears to be the result of an immune reaction of the body to specific strains of streptococcal bacteria. A week or two after a streptococcal throat infection, the initial symptoms of rheumatic fever may appear. Vigorous and complete antibiotic treatment of streptococcal sore throats will largely prevent the occurrence of rheumatic fever.

One of the problems in preventing rheumatic fever is that sore throats that result from harmless viral infections are often difficult to distinguish from those caused by streptococci. To be sure that streptococcal throat infections are treated properly, throat cultures are obtained to identify the organisms. If the throat culture result is positive, your physician will institute appropriate antibiotic treatment. If the antibiotic is administered orally, all of the prescribed drug must be taken, even though the sore throat disappears within the first day or two.

Rheumatic fever still occurs relatively rarely. The vast majority of streptococcal throat infections do not lead to rheumatic fever. When rheumatic fever does occur, itusually occurs in children around the age of 5-15 years.

Signs and Symptoms:

Diagnosis of rheumatic fever is clinical and depends on certain major and minor criteria.

Major criteria (two of the following must be present for the diagnosis to be made):

1. Inflammation of the heart (carditis), sometimes manifested by weakness and shortness of breath;
2. Inflammation of joints or Arthritis that tends to migrate from one joint to another;
3. Uncontrolled movement of limbs and face (chorea);
4. Raised, red patches on the skin;
5. Lumps under the skin (subcutaneous nodules).

Minor criteria (presence of one major and two minor criteria and evidence of a throat infection suggest the diagnosis of rheumatic fever):

1. Joint aches without inflammation;
2. Fever;
3. Previous rheumatic fever or evidence of rheumatic heart disease
4. Abnormal heart beat on electrocardiogram (ECG);
5. Blood test indicating presence of inflammation (ESR).

Diagnosis: The signs and symptoms detailed above provide quite distinctive criteria for your physician’s diagnosis of rheumatic fever.

How Serious Is Rheumatic Fever?

Rheumatic fever can result in inflammation in one or several organs. Most often, several joints are affected with an arthritic swelling, redness, and the sensation of heat. The heart valves may become inflamed (carditis) so that they fail to close properly. This causes regurgitation and inefficiency of the heart pump. In rare instances, the heart muscle itself is overwhelmed by the inflammation and death from heart failure occurs.

The heart inflammation may resolve with no permanent effects. However, there may be permanent scarring of one or more valves, which may result in obstruction to blood flow (stenosis) or reversed (backward) flow of blood (regurgitation or insufficiency). Sometimes, over a period of months or years, serious complications develop and surgery ultimately may be required to repair or replace the damaged heart valve or valves.

If rheumatic fever affects the brain, uncoordinated or uncontrolled movements of the limbs or facial muscles may occur. Such movements are described as chorea, a word derived from the Greek word meaning to dance. In the past, it was common for people to refer to this complication of rheumatic fever as Saint Vitus dance.

Rheumatic fever also can produce disc like raised and red areas on the skin called erythema marginatum. Lumps or nodules may form beneath normal-appearing skin.

Treatment:

Prevention: Rheumatic fever is avoidable. Pay close attention whenever your child develops a sore throat, especially if it persists for more than 24 hours and is accompanied by a fever. Consult your physician. If your physician suspects the presence of a streptococcal throat infection, he or she will collect a specimen by wiping the back of the affected person’s throat with a cotton swab. This specimen then will be used in laboratory tests. If certain types of streptococci are detected, your physician can prescribe an appropriate antibiotic drug. In many cases, this will be penicillin.

Treating a patient with Rheumatic Fever:

1. Antibiotics are given to eliminate any remaining streptococcal organisms. Usually, some kind of a suppressive schedule of antibiotics is continued for several years to prevent second attacks of rheumatic fever.
2. Large doses of aspirin, and sometimes cortisone-like drugs, may be given to suppress the inflammatory process of rheumatic fever.

Remember, a sore throat is a common, and usually minor, problem. However, if a streptococcal infection is present and left untreated, serious life-long heart complications potentially can result from a bout of rheumatic fever.