Rheumatic Fever

Definition

Rheumatic fever is a type of inflammatory disease occurring following sore throat or scarlet fever due to infection by group A streptococcus. It is most common in children in the age group of 5-15 years and only few adults (about 20%) suffer from this disease. It is quite rare in developed countries like the United States but more common in developing countries. Symptoms usually appear after 2 to 4 weeks after streptococcal sore throat.

Common symptoms include fever, painful joints, difficulty in breathing and palpitation. Untreated rheumatic fever leads to permanent heart damage (heart muscle and valves) which only becomes evident in the senior years. It is often associated with people who have a lack of access to proper medical care in their childhood. Treatment options include administration of antibiotics, anti-inflammatory drugs and anti-convulsant drugs.

Symptoms

The symptoms of rheumatic fever may vary from person to person while some people experience several symptoms many suffer from only a few. Even the nature of the symptoms may change during course of the disease.

Symptoms are :

  • High fever.
  • Painful joints mainly affecting the ankles, knee, elbows or wrists. The pain of the joints is typically migratory in nature. The affected joints become red, swollen and appears warmer in comparison to normal joints.
  • Chest pain, rapid, fluttering sensation in the chest, respiratory distress, increased tiredness.
  • Small, painless nodular lesions beneath the skin, flat or slightly raised rashes with irregular edge in the skin known as erythema marginatum.
  • Jerky uncontrollable movement of the hand, feet or face known as Sydenham chorea.
  • Emotional outburst.

Inflammatory changes due to rheumatic fever may last from weeks to month and in some cases may lead to complications. The heart is the organ which is mostly affected by rheumatic fever. Although any valve can be affected, the most commonly involved valve is the mitral valve which regulates the flow from one chamber to the other chamber on the left side of the heart. Common presenting features of cardiac involvement are fainting, fatigue, worsening of breathing difficulty, swelling of whole body due to fluid accumulation and the production of pink, frothy sputum.

Causes

Rheumatic fever is a systemic disease which affects many systems but mainly the heart. The disease commonly occurs following group A hemolytic streptococcal throat infection and less commonly after scarlet fever. The cell wall of the bacteria, group A Streptococcus pyogenes, contains a special protein having structural similarities with certain tissue proteins in the body.

The immune system of the affected person produces antigens against these bacterial proteins which may cross react with structurally-similar tissue proteins, especially those of the heart, joints, skin and central nervous system. This cross-reaction leads to severe often permanent inflammatory changes in the above mentioned organs.

The heart is the most commonly affected organ. Frequently seen damage to the heart includes narrowing of the openings of the valves (stenosis), leakage of blood in the opposite direction through the damaged valves (regurgitation), damage to the heart muscles, heart failure and problem in rhythm of the heart (palpitation, arrhythmia).

Risk factors

  • Poor environmental condition like overcrowding, poor sanitation leads to increased chance and frequency of spread of streptococcal sore throat.
  • Family history of rheumatic fever.
  • Some strains of streptococci are more likely to cause rheumatic fever.

Treatment

Treatment options include antibiotics like usually penicillin to control the infection, anti-inflammatory drugs like NSAIDs to reduce pain and inflammation and drugs to control convulsions. Antibiotics are often continued for prolonged period. Surgery like heart valve replacement is only necessary much later in life and only if the heart valve disease is severely impairing cardiac function.

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