Rheumatic Fever
Rheumatic Fever - Definition
Rheumatic fever is a condition that sometimes develops when scarlet fever or strep throat is not adequately treated. Both scarlet fever and strep throat are bacterial infections that are caused by group A streptococcus bacteria.
Rheumatic fever causes development in people of any age but it most commonly occurs in children between the ages of 5 and 15 years old. Strep throat is a common infection, but rheumatic fever is rare in the United States. Rheumatic fever is still a major public health problem in developing countries.
Rheumatic fever causes an inflammatory condition that can lead to permanent damage to the heart valves and heart failure. Treatment of the condition is aimed at decreasing the inflammation, reducing pain and other symptoms, and preventing the condition from recurring.
Prevalence
Rheumatic heart disease and acute rheumatic fever cause death due to cardiovascular conditions in children 5 years of age and younger in developing countries, and they affect almost 20 million people in these countries.
In developed countries, probably due to the routine use of antibiotics and improved hygienic standards, the incidence of acute rheumatic fever is much lower. Only 2 to 14 cases occur in every 100,000 people. Much of the time when cases occur, they happen as part of local outbreaks. In the mid-1900s epidemics, untreated acute strep sore throats were complicated by rheumatic fever as often as in 3% of cases. When cases are endemic, the incidence is much less.
Reasons for Rheumatic Fever
Rheumatic fever most often occurs following strep throat, which is a sore throat caused by group A streptococcus, or less often, after scarlet fever. Rarely, rheumatic fever causes by group A strep infections of other areas of the body, such as the skin.
Scientists aren't sure exactly what links rheumatic fever causes and strep bacteria. It seems as though the protein in the bacteria protein confuses the body's immune system, causing inflammation in tissues of the joints, central nervous system, skin, and the heart.
With the antibiotics currently available to treat and eliminate bacterial infections, there is little chance of a child who has treated appropriately for strep infection to develop rheumatic fever. If a child has scarlet fever or strep throat and isn't treated or the infection is not completed eliminated, he or she may develop rheumatic fever causes.
The connection between strep disease and rheumatic fever isn't clear, however, it gives the idea that the bacteria traps a person's immune system. The strep bacteria contain a protein like one found in specific tissues of the body. So immune system cells that would typically focus on the bacteria may regard the body's own particular tissues as though they were infectious agents — especially tissues of the heart, joints, skin, and focal sensory system. This immune system response brings about irritation.
Your child should get immediate treatment with an anti-infection to dispose of the strep microorganisms and takes all drugs as endorsed by your specialist, leaving a small chance of getting a rheumatic fever. If your child has at least one scene of strep throat or scarlet fever that isn't treated totally, he or she may develop rheumatic fever.
Risk Factors
The risk for rheumatic fever may be increased by factors such as:
- The type of bacteria: Specific strains of strep typically is one of the common rheumatic fever causes
- Family history: There is a genetic factor that makes some people more prone to rheumatic fever causes.
- Environmental factors: Rheumatic fever causes poor sanitary conditions, overcrowding, and other living conditions that more easily result in the rapid transmission of the strep bacteria
Complications
Rheumatic fever causes inflammation that can last over the course of a few weeks to a few months. Sometimes, the inflammation can cause long-term complications associated with the heart.
Permanent damage done to the heart caused by the inflammation of rheumatic fever is known as rheumatic heart disease. This complication most often causes problems with the valve that is located between the left chambers of the heart (the mitral valve) but it may also affect the other heart valves as well. Valve damage can cause the following conditions to occur:
- Valve stenosis: This is a narrowing of the valve which restricts the amount of blood flowing through the heart.
- Valve regurgitation: In this condition, the valve leaks, causing blood to back up in the wrong direction.
- Damage to heart muscle: This is a weakening of the heart muscle itself caused by rheumatic fever, causing decreased pumping action
Any injury to the heart due to rheumatic fever can lead to problems with the function of the heart later in a person's life. Problems that may result include:
- Heart failure: The heart cannot pump blood effectively enough to the body
- Atrial fibrillation: The heart's rhythm is irregular, resulting in a weakened pumping action
Rheumatic Fever - Symptoms
Some people develop several severe symptoms of rheumatic fever and others only have a few symptoms. The severity and type of symptoms of rheumatic fever may also vary over the course of the illness. Rheumatic fever typically develops within 14 to 28 days following of strep throat.
The symptoms of rheumatic fever and sign are a result of the swelling of the tissues of the skin, joints, heart or central nervous system and they may include:
- Tender and painful joints, typically the knees, ankles, wrists or elbows; less often hips, shoulders, feet, and hands are painful
- Fever
- Swollen, hot and reddened joints
- Nodules or lumps under the skin that are small and non-tender
- Pain and tenderness in one joint move to another one
- Heart murmur
- Chest pain
- Fatigue
- A painless rash that is slightly raised or flat and has an uneven or ragged border (erythema marginatum)
- Sudden emotional outbursts and unusual behaviors such as laughter or crying accompanied by St. Vitus' dance
- Uncontrolled movements of the body that are jerky and occur most typically in the face, feet, and hands
When to see a doctor
Prompt and adequate treatment of strep throat can prevent symptoms of rheumatic fever, so any child who has signs or symptoms of strep throat should be evaluated by a physician. Signs of strep throat include:
- A painful throat with swollen and tender lymph nodes
- A painful throat with no signs of a cold
- Painful swallowing
- A red rash occurring with a sore throat, starting at the neck and head, then extending to the abdomen, back, and extremities
- A strawberry tongue. The tongue is bright red with tiny bumps covering it
- Bloody or thick mucus from the nose. This is more common in children less than 3 years old
If any of the following are present, notify your physician:
- Newborns up to 3 months old: A fever of 100.4 F (38 C) or higher (taken rectally)
- Children ages 3 to 6 months old: A fever of 102 F (38.9 C) or higher
- Children ages 6 months to 2 years old: A fever of 102 F (38.9 C) or higher that lasts longer than one day or does not come down with medication
- Children ages 2 to 17 years old: A fever of 102 F (38.9 C) or higher that lasts longer than three days or does not come down with medication
Contact your physician if your child has any other signs and symptoms of rheumatic fever.
Diagnostic Procedures
A diagnosis of rheumatic fever is based on a physician's examination and results of tests. The severity of the symptoms of rheumatic fever will tell which treatment option would work best for a certain individual.
Physical examination
A physical exam may be requested to diagnose symptoms of rheumatic fever. The physical exam may include:
- Evaluation of fever
- Evaluation of the joints for inflammation/swelling
- Looking for nodules under the skin which are typical of rheumatic fever
- Examining the skin for a rash common with rheumatic fever
- Evaluating heart sounds for any murmurs or an abnormal rhythm that may be a sign of cardiac inflammation
- Evaluating the central nervous system for inflammation by conducting simple movement tests
Tests for strep infection
If your child has had a recent strep infection, an additional test to check for group A strep may not be needed. If a test is ordered, typically it will be a blood test.
Blood Test
In the event that your child has been determined to have symptoms of rheumatic fever, your specialist won't arrange extra tests for the bacterium. Your specialist would arrange a test, it will in all likelihood be a blood test that can recognize antibodies to the strep bacterium circulating in the blood. The genuine bacterium may never again be perceivable in your child's throat tissues or blood.
Your specialist may additionally check for aggravation in your child's blood by measuring C-receptive protein and the erythrocyte sedimentation rate.
Electrocardiogram (ECG or EKG)
This test records the electrical activity of the heart, allowing your physician to detect problems that can indicate impaired heart function or inflammation in the tissues of the heart. This test is non-invasive, meaning that no needles or injections are required if your doctor suspects rheumatic fever.
Echocardiogram
If your physician suspects rheumatic fever this test may be recommended. It uses sound waves to produce images of the heart like video pictures. This can show your physician if any of the heart valves are damaged or inflamed. Rheumatic fever does not typically cause heart valve damage early in the disease, but the test may need to be repeated later if there are changes in the patient's condition.
Rheumatic Fever - Treatment
Ordinary, long-term treatment can significantly diminish the danger of rheumatic fever and other medical issues related to rheumatic fever. Elective medicines fill in as supplements to conventional care and treatment for rheumatic fever - facilitating symptoms of the disease and evading recurring attacks.
Your specialist will prescribe rest and penicillin or different anti-toxins to dispose of the streptococcal microorganisms. To avoid getting the disease again, you might be put on a long-term treatment of anti-infection agents. For fever, irritation, arthritis and joint pain, and different side effects, you might be given a pain reliever like ibuprofen or naproxen, and maybe a corticosteroid. In the event that you have developed rheumatic fever, it will likewise be essential to take antibiotics under specific circumstances, for example, before dental checks or surgery - which may coincidentally bring microorganisms into the blood, to keep the fever from repeating. On the off chance that inflammation to the heart is serious, surgery may be needed to repair harm to the heart valves to avoid heart failure.
Goals for treatment for rheumatic fever include the following:
- Destroying any of the group A strep bacteria that may still be present in the body
- Relieving the symptoms of rheumatic fever
- Decreasing the inflammation
- Preventing further episodes of rheumatic fever
Treatment for rheumatic fever may include the following:
- Antibiotics: In order to get rid of any strep bacteria that may still be present in the body, your physician will prescribe an antibiotic. When this course of medication is completed, another course of medication will be started to prevent rheumatic fever from returning. Most children need to continue these preventative antibiotics until they are adults. If your child is an adolescent or a teen when they develop rheumatic fever, they may have to continue the medications until they have taken it for a minimum of five years. If there is evidence of cardiac (heart) inflammation due to rheumatic fever, antibiotics may be recommended for an even longer period of time or for the rest of a person's life.
- Anti-inflammatory treatment: A pain medication like ibuprofen or naproxen are usually recommended as a treatment to help reduce the inflammation, relieve pain and control fever. In severe cases, corticosteroids like prednisone are sometimes used.
- Anticonvulsant medications: valporic acid and carbamazepine.
- Bedrest. Your doctor may encourage you to relax and refrain you from doing tiring activities. Bed rest ensures that your body recuperates and heals completely, at least until major signs and symptoms have gone away. Bed rest is recommended for a few weeks up to a few months, especially if the rheumatic fever caused any heart problems.
Prevention
The best approach to ensure that your child doesn't get the rheumatic fever is to treat their strep throat infection completely. This implies ensuring your child finishes every single recommended dosage of medication by your doctor. Likewise, plan a follow-up visit to your doctor to guarantee that your child is free from strep bacteria.
Having appropriate cleanliness methods can help counteract strep throat. These include:
- Covering your mouth when hacking or sniffling
- Washing your hands
- Maintaining a strategic distance from contact with individuals who are infected
- Steering clear of personal things that sick people have touched
Long-term care
Follow-up care is usually decided on a case-by-case basis, so discuss with your physician what care will be needed for your child. In many cases, the heart damage caused by rheumatic fever does not become apparent until many years following the acute infection. When your child is an adult, it will be important that he or she knows they had rheumatic fever as a child so they can make their health care providers aware of this and discuss it with them.
The only way doctors know how to prevent rheumatic fever from occurring is to treat scarlet fever and strep throat infections promptly and thoroughly with a complete course of an appropriate antibiotic therapy.
Useful Advice
Bed rest is sometimes recommended for children who have been diagnosed with rheumatic fever. It's often best if these children's activities are restricted to allow their body to heal from the inflammation and the pain and fever to resolve. If heart inflammation is present, your physician may recommend that your child is placed on strict bed rest for a longer period of time, depending on the severity of inflammation.
Rheumatic fever is not common in the United States. Strep throat and the gathering A streptococcus microscopic organisms are still genuinely regular all through the western world. Left untreated, strep throat can wind up as rheumatic fever and treatment for rheumatic fever may be needed.
Also, rheumatic fever can prompt various health issues, including conditions identified with your heart that can be difficult to recover from. In the event that you begin to see indications of strep throat or rheumatic fever for yourself or your child, make a point to go see a specialist and get a full diagnosis and from that point, treatment before significant damage can start.
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