Monday, November 19, 2007

Rheumatic Fever

Rheumatic Fever

Rheumatic Fever is an inflammatory disease, which occurs as a delayed sequel to pharyngeal infection with streptococcal bacteria. It involves principally the heart, joints, central nervous system and skin. About half of the children who previously had rheumatic fever will develop it again with another streptococcal throat infection. Rheumatic fever follows streptococcal infections of the throat but not those of the skin (impetigo) or other areas of the body; the reasons are not known. Symptoms of rheumatic fever generally appear within five weeks after an untreated streptococcal (strep) throat infection.There's no cure for rheumatic fever. But it can be prevented by prompt and thorough treatment of a strep throat infection with antibiotics.When it seemed to disappear, people thought it had become a disease of the past. After its resurgence, we learned that rheumatic fever comes and goes in waves. It can cause serious illness wherever strep throat occurs.

Rheumatic fever is a serious inflammatory condition that can affect many parts of your body - heart, joints, nervous system and skin. Rather, it is an inflammatory reaction to the infection. Rheumatic fever can damage body tissues by causing them to swell, but its greatest danger lies in the damage it can do to your heart. More than half of the time, rheumatic fever leads to scarring of the heart's valves.

In fact, even in untreated cases, only a small percentage of people with strep throat develop rheumatic fever. Overcrowded living conditions seem to increase the risk of rheumatic fever, and heredity seems to play a part. In the United States, a child who has a streptococcal throat infection but is not treated has only a 0.4 to 1% chance of developing rheumatic fever. But it can be prevented by prompt and thorough treatment of a strep throat infection with antibiotics. In many cases, rheumatic fever may affect the heart valves (rheumatic carditis) and interfere with normal blood flow through the heart.Because of antibiotics, rheumatic fever is now rare in developed countries.

A rare but potentially life-threatening disease, rheumatic fever is a complication of untreated strep throat, by bacteria called Group A Streptococcus. The disease is twice as common in females as it is in males. Although rheumatic fever can occur at any age, it most frequently occurs in children between the ages of 6 and 15 years. Before antibiotic medicines became widely used, rheumatic fever was the single biggest cause of valve disease .Rheumatic fever is a condition that is a complication of untreated strep throat.However, the greatest danger from the disease is the damage it can do to the heart.In more than half of all cases, rheumatic fever scars the valves of the heart, forcing this vital organ to work harder to pump blood. In the United States, rheumatic fever rarely develops before age 4 or after age 18 and is much less common than in developing countries, probably because antibiotics are widely used to treat streptococcal infections at an early stage.

Causes of Rheumatic Fever

The common Causes of Rheumatic Fever :

Rheumatic fever primarily affects children between ages 6 and 15 and occurs approximately 20 days after strep throat or scarlet fever.

The rate of development of rheumatic fever in individuals with untreated strep infection is estimated to be 3%.

Streptococcal antigens, which are structurally similar to those in the heart, include hyaluronate in the bacterial capsule, cell wall polysaccharides (similar to glycoproteins in heart valves), and membrane antigens that share epitopes with the sarcolemma and smooth muscle.

The antibodies begin with the joints and often move on to the heart and surrounding tissues.

Persons who have suffered a case of rheumatic fever have a tendency to develop flare-ups with repeated strep infections.

One possible cause for this is the similarities between streptococcal antigens and heart valve proteins and heart muscle cells

RF only develops in children and adolescents following GABHS pharyngitis, and only infections of the pharynx initiate or reactivate RF.

If the antibodies attack your heart, they can cause your heart valves to swell, which can lead to scarring of the valve "doors."

Symptoms of Rheumatic Fever

Some are common Symptoms of Rheumatic Fever :

Joint pain, migratory arthritis - involving primarily knees, elbows, ankles, and wrists

Stomach pain or feeling less hungry.

Sore throat

weight loss

A raised, red rash on your chest, back, or stomach.

Joint swelling; redness or warmth

Small bumps under the skin over your elbows or knees (called nodules).

Abdominal pain

stomach pains


Joint pain


Treatment of Rheumatic Fever

Here is the list of the methods for treating Rheumatic Fever :

The management of acute rheumatic fever is geared towards the reduction of inflammation with anti-inflammatory medications such as aspirin or corticosteroids.

Individuals with positive cultures for strep throat should also be treated with antibiotics.

Continue prednisone for 2-6 weeks depending on the severity of the carditis, and taper prednisone during the last week of therapy.

Another important cornerstone in treating rheumatic fever includes the continuous use of low dose antibiotics (such as penicillin, sulfadiazine, or erythromycin) to prevent recurrence.

Anti-inflammatory doses of aspirin may be associated with abnormal liver function tests and GI toxicity, and adjusting the aspirin dosage may be necessary.

To reduce inflammation of your heart or joints, your doctor may recommend specific doses of aspirin or an over-the-counter or prescription nonsteroidal anti-inflammatory medication.

Treatment for rheumatic fever can involve several approaches, including antibiotics and anti-inflammatory medications, bed rest and, in the most serious cases, surgical repair of damaged heart valves.

The length of bed rest will be determined by your child's physician, based on the severity of your child's disease and the involvement of the heart and joints. Bed rest may range from two to twelve weeks.
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