health talk:with Dr Johannes Marisa
Rheumatic fever is an inflammatory disease that can develop when strep throat or scarlet fever is not properly treated. Strep throat and scarlet fever are caused by an infection with streptococcus bacteria.
Rheumatic fever most often affects children who are between five and 15 years old, though it can develop in younger children and adults. The condition remains common in many developing countries.
Estimates suggest that about 33,4 million people worldwide have rheumatic heart disease and there are approximately between 300 000 and 500 000 new cases of rheumatic fever annually.
Rheumatic fever can cause permanent damage to the heart, including damaged heart valves and heart failure.
Symptoms
Symptoms vary. You may have few symptoms or several and some symptoms can change during the course of the disease. The onset of rheumatic fever usually occurs about two to four weeks after a streptococcal throat infection. The rheumatic fever symptoms and signs, which result from inflammation in the heart, joints, skin or the central nervous system, can include:
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lFever.
lPainful and tender joints most often in the knees, ankles, elbows and wrists.
lPain in one joint that migrates to another joint.
lRed, hot or swollen joints.
lSmall painless bumps beneath the skin.
lChest pains.
lFlat or slightly raised, painless rash with a ragged edge.
lJerky, uncontrolled body movements (Sydenham chorea) most often in the hands, feet and face.
lOutbursts of unusual behaviour, such as crying or inappropriate laughing that accompanies Sydenham chorea.
Precautions
In the event that there is suspicion of streptococcal throat infection, seek medical attention early, preferably within five days. Sore throat infection can present with the following:
lSore throat that comes on suddenly.
lPain when swallowing.
lFever.
lHeadache.
Causes Rheumatic fever can occur from a throat infection from a bacterium called Group A streptococcus. Group A streptococcus infections of the throat cause strep throat or, less commonly, scarlet fever.
Group A Streptococcus infections of the skin or other parts of the body rarely trigger rheumatic fever.
It is thus important to allow your child to receive prompt treatment with antibiotics to eliminate strep bacteria and take all medication as prescribed.
Failure to treat or having inadequate treatment might see your child developing rheumatic fever.
Complications The inflammation caused by rheumatic fever can last a few weeks to several months. In some instances, the inflammation causes long-term complications.
Rheumatic fever can cause permanent damage to the heart. It can occur 10 to 20 years after the original illness, but severe cases of rheumatic fever can cause damage to the heart valves while your child still has symptoms. Problems are most common with the valve between the two left chambers of the heart, but the other valves can be affected. The damage can thus result in:
lNarrowing of the valve (Stenosis): This decreases blood flow
lLeak in the valve (Regurgitation): A leaky valve causes blood to flow in the wrong direction
lDamage to the heart muscle: The inflammation associated with rheumatic fever can weaken the heart muscle, affecting its ability to pump.
Damage to the mitral valve or other valves can cause problems with the heart later in life. Resulting conditions can include:
lAn irregular or chaotic heartbeat.
lHeart failure.
Diagnosis
Diagnosis is based on medical history, physical examination and certain tests.
Blood tests: If your child was already diagnosed with a strep infection using a throat swab test, there may not be any further need for additional tests for the bacteria.
Anti-streptolysin O titre: Antibodies to strep bacteria might be detected serially.
C-Reactive protein and erythrocyte sedimentation rate: These are inflammatory markers in the blood.
Electrocardiogram (ECG): This records electrical signals as they travel through the heart.
Echocardiogram: Live-action images of the heart can help your doctor detect heart problem.
Treatment
The goals of treatment for rheumatic fever are to destroy remaining Group A Streptococcal bacteria, relieve symptoms, control inflammation and prevent the condition from returning. Treatments include:
lAntibiotics: Penicillins are usually the drugs of choice. Preventive medication can also be given up to the age of 21. Those who had heart inflammation during rheumatic fever might be advised to continue preventive antibiotic treatment for 10 years or longer.
lAnti-inflammatory treatment.
lAnticonvulsant medications: For severe involuntary movements caused by Sydenham chorea, anti-seizure drugs like valproic acid or carbamazepine can be used.
lDr Johannes Marisa is a medical practitioner and public health practitioner who can be accessed on: [email protected]
