The Rheumatic fever is an inflammatory disorder that can be caused by a strep throat ( sore throat ) inadequately treated: strep throat is caused by a bacterial infection caused by group A streptococcus .
Rheumatic fever most often affects children and young people aged 5 to 15 years, but can also affect younger children or adults. It is very rare in the United States and other developed countries, but is most common in several developing countries.
Rheumatic fever can cause permanent damage to the heart, particularly the heart valves, or it can cause heart failure. The therapies are able to reduce tissue injury due to inflammation, relieve pain, other symptoms and prevent relapse.
Rheumatic fever can begin after a throat infection caused by a bacterium called Streptococcus pyogenes, or Streptococcus group A. The group A streptococcal infections may cause pharyngotonsillitis or, in rarer cases, the scarlet fever . Infections of the skin or other parts of the body due to group A streptococcus rarely cause rheumatic fever.
The exact relationship between streptococcal infection and rheumatic fever is unclear, but it seems that the bacterium “tricks” the immune system: streptococcus, in fact, contains a protein similar to that found in certain body tissues. The cells of the immune system, which under normal conditions would destroy the bacteria, the body’s tissues may process the infectious agents. Among the tissues of the body most affected are those of the heart, joints, skin and central nervous system. The immune reaction produces inflammation.
If your child is treated promptly and completely with the antibiotic to eliminate strep, taking all prescribed doses of the drug, the risk of developing rheumatic fever is very low or zero. However, if your child has several times in a row of scarlet fever or strep infection promptly or completely untreated, there is the risk of developing rheumatic fever.
Among the factors that increase the risk of suffering from rheumatic fever include:
Family history. Some people may be carriers of a gene or genes that make them more prone to rheumatic fever.
Type of streptococcus. Some strains of Streptococcus increase the risk of suffering from rheumatic fever.
Environmental factors. The risk of suffering from rheumatic fever increases living in overcrowded environments, in conditions of poor hygiene or other conditions that can facilitate the rapid transmission or repeated exposure to the bacteria.
The symptoms of rheumatic fever vary depending on the patient, while some people suffer from various symptoms, others just complain about it. Symptoms also can change over the course of the disease.
Rheumatic fever usually occurs two to four weeks after streptococcal pharyngitis, including the symptoms of rheumatic fever, caused by inflammation of the heart, joints, skin or central nervous system, include:
Pain and joint problems, notably on the ankles, knees, elbows or wrists. In rare cases they can also affect the shoulders, hip, hands and feet.
Pain that travels from joint to another.
Joints red, swollen or hot.
Small painless nodules under the skin.
Palpitations (sensation of rapid heartbeat, restlessness or feeling of heart pounding).
Shortness of breath.
Erythema marginatum (rash with areas of flat or slightly raised and irregular borders).
Convulsive and uncontrollable body movements (chorea or St. Vitus’s dance of Sydenham), affecting in particular the hands, feet and face.
Unusual and uncontrollable behaviors, such as tears and laughter of Sydenham’s chorea convulsive symptoms.
When to call your doctor
You should bring your child to the doctor when you experience symptoms of streptococcal pharyngitis, because it is possible to prevent rheumatic fever treating streptococcal pharyngitis carefully. Call your pediatrician if your child has one of the following symptoms:
Sore throat accompanied by symptoms of colds , runny nose, for example,
Sore throat, lymph nodes (glands) sore and swollen,
Swallowing problems, even saliva,
Often or nasal mucus containing blood, most likely in children younger than 3 years,
In case of fever, notify your pediatrician in the following situations:
Babies up to 6 weeks with fever equal to or greater than 37.5 ° C
Children from six weeks to two years, with fever over 38.5 ° C
Children older than 2 years, with fever over 39.0 ° C
Also for fever that lasts for more than three days.
Consult your pediatrician when your child has other signs and symptoms of rheumatic fever.
The inflammation caused by rheumatic fever may last from several weeks to several months. In some cases the inflammation can cause complications in the long run.
Rheumatic heart disease is the permanent injury caused by inflammation of the heart due to rheumatic fever: the problems occur with increased frequency in the valve that separates the two chambers of the right heart (mitral valve), but can be also affected other valves. The lesions can cause one of the following two problems:
Valve stenosis. This is a narrowing of the heart valve, causing a decrease in blood flow.
Valvular regurgitation. The valve does not close completely, so blood can flow in the wrong direction.
Injuries of the heart muscle. Inflammation linked to rheumatic fever can weaken the heart muscle, which fails to properly perform the function of the pump.
The lesions of the mitral valve, other cardiac valves or other tissues can cause heart problems in later life. Among the resulting problems include:
Atrial fibrillation, irregular heart beat that the upper chambers of the heart (atria)
Heart failure, ie inability to pump enough blood in the body.
The diagnosis of rheumatic fever is based on:
Signs and symptoms reported by the patient,
Symptoms of inflammation,
Signs of recent infection with group A streptococci
The pediatrician will visit your child carefully, checking for example:
joints, looking for signs of inflammation,
the skin, looking for rashes or lumps under the skin,
heartbeat, to discover arrhythmias, murmurs or muffled sounds that might indicate cardiac inflammation.
The doctor also may do a series of joint mobility tests to find indirect evidence of inflammation of the central nervous system.
Tests for strep infection
If your child has been diagnosed with streptococcal infection, your doctor will probably not run a specific test to detect the bacterium. If your doctor prescribes an examination, in all probability it will be a blood test to detect antibodies to Streptococcus circulating in the body. The bacteria, in fact, probably will not be present in the tissues of the throat or in the blood.
The electrocardiogram (ECG) records the electrical signals that spread in the heart of your child. The doctor may detect the irregularities of these signals that indicate inflammation of the heart or heart failure.
The echocardiogram uses sound waves to produce images of the heart in real time and in motion. This simple test allows the doctor to discover the alterations of cardiac structures. The lesions rarely affect the heart valves in the early stages of the disease, but can still be viewed echocardiography.
Care and Treatment
The goal of therapy of rheumatic fever is to destroy all group A streptococci in the body, relieve symptoms, control inflammation and prevent relapses.
Among the therapies used to fight rheumatic fever include:
The pediatrician will prescribe penicillin or another antibiotic to eliminate all the streptococci in the body of your child.
After completing the first course of antibiotics, the doctor will prescribe a second to prevent relapse. This second preventive therapy usually must continue up to twenty years of age. If your child has been affected by rheumatic fever as a teenager, probably should continue to take antibiotics even after 20 years and complete a preventive therapy for at least five years.
For those in rheumatic fever has been suffering from heart inflammation, it may be advisable to continue preventive therapy for a longer period or even for life.
Your doctor will prescribe an analgesic, such as the ‘ aspirin or naproxen to reduce inflammation, fever and pain. If symptoms are severe or the child has not improved after therapy with anti-inflammatory drugs, the doctor will prescribe a steroid such as prednisone.
If the involuntary movements caused by Sydenham’s chorea are severe, your doctor may prescribe an anticonvulsant such as valproic acid or carbamazepine.
Ask your doctor what are the necessary controls and measures to be taken to safeguard the long-term health of your child. The cardiac lesions due to rheumatic fever may remain asymptomatic for many years after the acute episode. Your child should be informed about the fact that he suffered from rheumatic fever and, once adult, in turn, should inform your doctor.
Lifestyle and practical remedies
The doctor may advise your child to remain at rest in bed and you to limit its activities until the inflammation, pain and other symptoms have improved. If the inflammation has also affected the heart tissue, your doctor may recommend complete bed rest for a few weeks or months, depending on the severity of inflammation.
The only sure way to prevent rheumatic fever is to treat streptococcal pharyngotonsillitis or scarlet fever promptly, with a full course of antibiotics.