Rheumatic Fever

Overview

Rheumatic fever also called acute rheumatic fever is a disease that affects the heart, skin, brain, and joints. It normally develops as a complication of improperly treated scarlet fever or strep throat both of which are caused by an infection with streptococcus bacteria.

Not every person who has a streptococcal infection develops rheumatic fever (RF) but if RF develops, its symptoms often appear 2 to 4 weeks after the infection.

Rheumatic fever is very common in children aged 5 to 15 years but it can also develop in younger children and adults.

Even though strep throat is common in the developed countries, rheumatic fever is rare, and while strep throat is not common in developing countries, rheumatic fever and even rheumatic heart disease are common.

Rheumatic fever is associated with permanent damage to the heart including heart failure and damaged heart valves. Treatment helps minimize damage from inflammation, reduce pain and other symptoms, and prevent the recurrence of the disease.

If not treated, RF can cause long-term complications such as rheumatic heart disease (RHD) that develops in about 45% of those with RF and it is responsible for between 230, 000 and 500, 000 deaths every year.

Symptoms

As mentioned, signs and symptoms of RF often develop 2 to 4 weeks after being infected with streptococcal bacteria. The most common symptoms include:

  • Headache
  • Trouble swallowing
  • Sore throat
  • Nausea and vomiting
  • Swollen, tender lymph nodes
  • Red skin rash
  • High temperature
  • Swollen tonsils
  • Abdominal pain

Some people may experience just one or two of the following symptoms while others may experience most of them:

  • Rapid heart rate
  • Fatigue
  • Joint pain and swelling
  • Decreased ability to exercise
  • Splotchy rash
  • Uncontrollable movements and twitching
  • Fever
  • Heart murmur

Causes

RF can occur after an infection of the throat with a streptococcus group A bacterium.

These infections cause strep throat, scarlet fever, and infections of the skin which rarely trigger rheumatic fever.

The connection between rheumatic fever and strep infection is not clear but it seems that the bacterium ruses the immune system.

Risk Factors

The risk factors of rheumatic fever include:

  • Family history: Certain individuals carry genes that might make them develop the disease.
  • Type of strep bacteria: Group A strep bacteria are likely to trigger RF than other strains.
  • Environmental factors: a greater risk of RF is linked to overcrowding, poor sanitation, and other conditions that can lead to rapid transmission or multiple exposures to strep bacteria.

Diagnosis

No single test can be used to diagnose rheumatic fever. Doctors often look for signs and symptoms of the disease, check the medical history of the patient, and use various tests to diagnose RF.

Some of the tests used by doctors include:

  • A blood test to look for antibodies that would indicate if the patient recently had a group A strep infection or not
  • A throat swab to check for a group A strep infection
  • A test of how well the heart is working – electrocardiogram or EKG
  • A test that creates a movie of the heart muscle working – echocardiography or echo

Treatment

Treatment will involve elimination of all the residual group A bacteria and managing the symptoms. This may include any of the following:

  • Antibiotics: They should be long-term to prevent the bacteria from recurring.
  • Anti-inflammatory treatment: Includes pain medications such as naproxen (Naprosyn, Aleve) or apirin (Bayer). Note that aspiring use in children should be cautious since it is associated with Reye’s Syndrome.
  • Anticonvulsant medications: Helps prevent or stop severe involuntary movements.
  • Bed rest: Bed rest and restricted activities help control major symptoms such as inflammation and pain. The doctor may recommend strict bed rest for a few weeks or a few months.

For more information on diagnosis and/or treatment, speak to a doctor, or get access to a hospital near you through the Uzima Health App.