Rheumatic fever

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Rheumatic fever is an inflammatory reaction to an infection (such as an untreated strep throat) caused by group A streptococcus bacteria. It is named rheumatic fever because of its similarities with the symptoms of rheumatism which involves the joints and connective tissues. According to the World Health Organization, rheumatic fever and rheumatic heart disease still remain to be one of the most common causes of cardiovascular disease in the whole world, most specifically in areas with poor living conditions. The agency recommends all countries to have a well-managed public health program to lessen the incidence of this disease.

Contents

Signs and symptoms

The symptoms of rheumatic fever usually appear during the first to fifth week of infection caused by the Group A streptococcus bacteria. The symptoms are:

  • Fever
  • Chest pain
  • Abdominal pain
  • Small, painless nodules beneath the skin
  • Shortness of breath
  • Swollen, painful, tender joints
  • Rapid, fluttering heart beat
  • Inappropriate laughing or crying
  • Sore throat without other cold symptoms such as runny nose
  • Jerky, uncontrollable body movements
  • Flat, or slightly raised painless rash with a ragged edge
  • Difficulty in swallowing
  • General weakness or fatigue
  • Blood discharge from the nose
  • Tender, swollen lymph nodes

Though some of the manifestations of this disease usually occur on different parts of the body, almost all of the symptoms resolve quickly. The only exception is rheumatic heart disease which may persist after all the other symptoms have disappeared. Typically, patients between the ages 5 to 15 years old are more prone to have rheumatic heart disease if they have been infected with rheumatic fever that starts with strep throat or scarlet fever.

Causes and risk factors

Rheumatic fever is brought about by an infection caused by group A streptococcus bacteria, such as strep throat or scarlet fever. The body releases antibodies to fight the infection. However, streptococcus has a protein similar to some tissues of the body. Thus, the antibodies are “tricked” into thinking that they also need to fight the tissues as if they are also causing the infection. Unfortunately, these tissues are the ones found in the heart, joints, skin, and the central nervous system.

Group A streptococcus bacterial infections on the skin or in other parts of the body rarely triggers rheumatic fever.

There are people who carry a gene or genes that makes a person more at risk for developing rheumatic fever. Moreover, the there are strains of the streptococcus bacteria that are more powerful and are more likely to cause rheumatic fever than the other strains.

Rheumatic fever has been considered a disease of the poor. The disease usually occurs in places that have poor environmental sanitation and are overcrowded therefore making transmission or multiple exposures to the bacteria possible.

Diagnosis and tests

  • Blood test for repeated strep throat infections
  • Complete blood count
  • Electrocardiogram (ECG) - To check for heart inflammation or poor heart function.
  • Echocardiography - Sound waves are used to produce live action images of the heart to check for inflammation. One of the late signs of rheumatic fever is the damage to the heart valves which can also be revealed by the echocardiogram.
  • Erythrocyte sedimentation rate (ESR) – To measure how much inflammation there is in the body.

Possible complication

Treatment, prevention, and control

Treatment of rheumatic fever focuses on the following:

  1. Get rid of remaining streptococcal infection.
  2. Lessen the inflammation of the heart.
  3. Limit physical activity to prevent further inflammation of the affected organs.
  4. Reduce mental and emotional stress.

Antibiotic treatment is administered to address the streptococcus bacteria. For children, penicillin taken orally or through injections may be recommended. Meanwhile, aspirin is also given to reduce fever, inflammation, and pain. For severe heart inflammation, corticosteroids, such as prednisone, may be given. Other medications, such as anti-convulsant medications, may be given to address complications. Total bed rest is advised to avoid adding more pain to the inflamed joints.

Since rheumatic fever is prevalent in over-populated areas, environmental sanitation is also promoted to help reduce infection. It is advised to immediately treat streptococcus infections with antibioticsto prevent the development of complications.

Cases in the Philippines

It has been documented that heart diseases, pediatric and adult cases combined, account for 8 percent of the cases in the hospitals in the Philippines. It appears that the cases are increasing year after year. The leading cause for cardiac disorders is rheumatic fever which accounts for 54.9% of pediatric cardiac cases and 46.6% of adult cardiac cases. The average prevalence rate for rheumatic fever is 47.1%. Cases of rheumatic disease are more frequent in the less fortunate patients. The Philippine Heart Association has been aiming to decrease the morbidity and mortality rates of rheumatic fever by implementing programs for it. At present, their goal is to deliver community-oriented programs to further improve the quality of care and to decrease the mortality and morbidity rates especially among the poor. The programs involve preventive, curative, and rehabilitative aspects of a patient who has rheumatic fever and rheumatic heart disease. In cooperation with the RF/RHD Foundation and the Department of Health, this program provides free penicillin treatment to indigent rheumatic fever and rheumatic heart disease patients.

References