Rheumatic fever

Rheumatic fever is an inflammatory disease that may develop after an infection with Streptococcus bacteria (such as strep throat or scarlet fever). The disease can affect the heart, joints, skin, and brain.

Causes

Rheumatic fever is common worldwide and is responsible for many cases of damaged heart valves. It is not common in the United States, and usually occurs in isolated outbreaks. The latest outbreak was in the 1980s.

Rheumatic fever mainly affects children ages 6 -15, and occurs approximately 20 days after strep throat or scarlet fever.

Symptoms

• Abdominal pain
• Fever
• Heart (cardiac) problems, which may not have symptoms, or may result in shortness of breath and chest pain
• Joint pain, arthritis (mainly in the knees, elbows, ankles, and wrists)
• Joint swelling; redness or warmth
• Nosebleeds (epistaxis)
• Skin nodules
• Skin rash (erythema marginatum)
  • Skin eruption on the trunk and upper part of the arms or legs
  • Eruptions that look ring-shaped or snake-like
• Sydenham chorea (emotional instability, muscle weakness and quick, uncoordinated jerky movements that mainly affect the face, feet, and hands)

Exams and Tests

Because this disease has different forms, no one test can firmly diagnose it. Your doctor will perform a careful exam, which includes checking your heart sounds, skin, and joints.

Tests may include:

• Blood test for recurrent strep infection (such as an ASO test)
• Complete blood count
• Electrocardiogram
• Sedimentation rate (ESR)

Several major and minor criteria have been developed to help standardize rheumatic fever diagnosis. Meeting these criteria, as well as having evidence of a recent streptococcal infection, can help confirm that you have rheumatic fever.

The major criteria for diagnosis include:

• Arthritis in several joints (polyarthritis)
• Heart inflammation (carditis)
• Nodules under the skin (subcutaneous skin nodules)
• Rapid, jerky movements (chorea, Sydenham chorea)
• Skin rash (erythema marginatum)

The minor criteria include:

• Fever
• High ESR
• Joint pain
• Other laboratory findings

You'll likely be diagnosed with rheumatic fever if you meet two major criteria, or one major and two minor criteria, and have signs that you've had a previous strep infection.

Treatment of Rheumatic Fever

There is no actual cure for rheumatic fever but medication can be provided to alleviate the pain caused by some of the symptoms. Recurrent occurrence of the streptococcal infection can be prevented by administering penicillin to the patient. Aspirin is usually given to reduce fever and sometimes, corticosteroids are given to the patient to combat joint pain and swelling.

Administering low doses of antibiotics such as penicillin, erythromycin or sulfadiazine over a long-term period will help in preventing strep throat from occurring again.

Bed rest will be recommended for some patients in order to give the body some time to heal. Intake of fluids should be increased and the patient should have at least 6-8 glasses of water per day.

Complications of Rheumatic Fever

Depending on the severity of the initial attack of the disease, some patients may develop the following complications:

• Heart inflammation: inflammation of the muscle or lining of the heart
• Rheumatic Heart Disease: problems causes in the condition of the heart due to previous episode of rheumatic fever
• Sydenham Chorea: involuntary / spasmodic movements of the body
• Arrhythmias: heart rhythm disorder
• Endocarditis: deals with abnormalities caused to the endocardium (innermost tissues that lines the heart’s chambers) – inflammation of the heart valves or the lining of its chambers can be caused due to rheumatic fever
• Congestive heart failure: a very serious condition where the heart is unable to pump sufficient blood to the rest of the body
• Pericarditis: inflammation of the pericardium or the sac-like covering of the heart

Prevention of Rheumatic Fever

Physicians do not know how to reduce the pace of the damage caused to heart valves due to rheumatic fever. Therefore, it is best to nip this problem in the bud and promptly treat diseases caused due to streptococcal infections with the timely intake of antibiotics.