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Rheumatic Fever

Definition

Rheumatic fever is a delayed immune response that can occur after infections with certain group A streptococcal bacteria. It causes damage to certain organs, particularly the heart.

What is going on in the body?

Strep throat and scarlet fever are two types of infections that precede rheumatic fever. If a person is not treated effectively with antibiotics for these infections, he or she may have an immune response. The effects of this response can be seen in the heart, joints, brain, and skin.
The most serious effect of rheumatic fever is a heart valve defect known as mitral stenosis. Rheumatic fever was more common before antibiotics were available to treat infections.

Risks

What are the causes and risks of the disease?

Rheumatic fever is an immune response to an infection with group A streptococcus. The same bacteria cause strep throat and scarlet fever. While streptococcal skin infections are relatively common, they have not been linked to rheumatic fever.
Rheumatic fever is most prevalent in school-age children who are 5 to 15 years old. It is seen most often in the cold winter months when strep throat is also most common. Rheumatic fever may also occur in adults. It is seen with equal frequency in men and women. However, women with rheumatic fever are more likely to develop Sydenham chorea and mitral stenosis.

Prevention

What can be done to prevent the disease?

Effective treatment of strep infections with antibiotics significantly lowers a person's risk of developing rheumatic fever. Individuals with these infections should take their full course of antibiotics, even after symptoms are gone.

Diagnosed

How is the disease diagnosed?

Diagnosis of rheumatic fever starts with a medical history and physical examination. The healthcare professional may also order diagnostic tests. These may include the following:
  • a throat culture
  • an antibody titer
  • an echocardiogram, or ultrasound of the heart
  • a chest X-ray
The American Heart Association has issued guidelines for the diagnosis of rheumatic fever. Known as the Jones criteria, these guidelines include lab test findings as well as signs and symptoms of the disease.

Long Term Effects

What are the long-term effects of the disease?

In 75% of people with rheumatic fever, the acute attack lasts only 6 weeks. Ninety percent of the cases of rheumatic fever resolve in 12 weeks or less, and more than 95% in six months or less.
The many possible complications of rheumatic fever include:
  • anemia, which is a low red blood cell count
  • arrhythmias, which are abnormal heart rhythms
  • arthritis
  • bacterial pericarditis, an inflammation of the sac surrounding the heart
  • congestive heart failure, a condition in which the weakened heart is unable to pump blood effectively throughout the body
  • endocarditis, which is an inflammation of the lining of the heart
  • heart valve damage, including mitral stenosis and mitral valve prolapse
  • proteinuria, a condition in which protein is lost in the urine
  • skin disorders
  • Sydenham chorea, a nervous system disorder that causes involuntary, writhing movements

Other Risks

What are the risks to others?

Rheumatic fever itself is not contagious and poses no risk to others. However, the streptococcal infection can be highly contagious.

Treatments

What are the treatments for the disease?

A person with strep throat will be given antibiotics such as penicillin and erythromycin. Nonsteroidal anti-inflammatory drugs (NSAIDs) such as aspirin and ibuprofen, may be used as needed for pain and fever. However, aspirin should not be used by children because of the risk for developing a serious neurologic condition called Reye syndrome.
A person who has rheumatic fever will be given antibiotics as well as NSAIDs. Corticosteroids, such as prednisone, may be used to modify the immune response. Bed rest is recommended for a person who has rheumatic fever. Some healthcare professionals prescribe digoxin (i.e., Lanoxin), a medicine that strengthens the contractions of the heart.
After the initial treatment, a slow increase in physical activity is allowed. Any complications are treated on a case-by-case basis.

Side Effects

What are the side effects of the treatments?

Antibiotics and pain medicines may cause stomach upset, rash, and allergic reactions. Corticosteroids can increase the person's risk of infection.

After Treatment

What happens after treatment for the disease?

A person who has had rheumatic fever may need lifelong treatment with antibiotics to prevent further attacks. He or she may also be advised to take preventive antibiotics before surgery or dental procedures.

Monitor

How is the disease monitored?

The healthcare professional will monitor a person for the complications of rheumatic fever, sometimes with repeated echocardiograms and other tests. Any new or worsening symptoms should be reported to the professional.

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