Thursday, November 27, 2014

Definition

Acuterheumatic fever is an inflammation that may affect many parts of the body. It can be a complication of streptococcal pharyngitis (strep throat), a type of bacterial infection of the throat.

Single or repeated episodes of rheumatic fever can lead to chronic rheumatic heart disease.

Description

Fortunately, not all streptococcal throat infections are followed by rheumatic fever. Signs of rheumatic fever usually begin 2 to 3 weeks after infection, but may appear as early as 1 week or as late as 5 weeks.

Although there have been reports of new outbreaks, rheumatic fever is uncommon in the U.S. except among recent immigrants. It most frequently occurs in children between 5 and 15 years of age. Rheumatic fever is rare before age 4 and after age 40.

Symptoms

  • Heart inflammation (carditis) affects about half the patients and has been reported in one- to two-thirds of children hospitalized during recent outbreaks. Carditis can lead to heart failure in some patients.
  • A bout of rheumatic fever can also damage the heart valves, and certain characteristic murmurs are nearly always audible during an acute attack of rheumatic carditis.
  • Heart damage may disappear or may persist. Permanent heart damage caused by rheumatic fever is called rheumatic heart disease.
  • About 75 percent of patients experience arthritis that affects multiple joints.
  • About 15 percent experience neurological abnormalities, often a type called Sydenham's chorea in which the muscles of the arms and legs flail uncontrollably.
  • Fewer than 10 percent of patients develop small painless lumps, or nodules, on prominent bones at the elbows, spine, knees, and ankles; or a rash may appear that resembles rings on the skin. In most cases, these problems eventually resolve.

Diagnosis

Diagnosis is based on the medical history and physical examination. Blood tests may be done.

Treatment

There is no cure for rheumatic fever once it has developed, although medications can be used to eradicate any remaining streptococcal infection and to control some of the symptoms.

Treatment consists of antibiotics, usually penicillin, bed rest, and aspirin or steroids. Aspirin may reduce fever, and relieve joint pain and swelling. Corticosteroids may be used if aspirin is inadequate.

Fortunately, recurrent streptococcal infections can be prevented very effectively with penicillin (Erythromycin may be substituted).

To prevent recurrent rheumatic fever in persons who have already had one episode, monthly injections of a long-lasting preparation of penicillin can be effective.

The risk of recurrence is higher in patients in whom the cardiac manifestations of acute rheumatic fever do not resolve, and those patients should receive antibiotic prophylaxis (protection) prior to dental or surgical procedures.

Questions

What tests need to be done for diagnosis and to determine the extent of damage or involvement?

Has any permanent heart damage been done?

What treatment do you recommend?

Will any medication be prescribed? What are the side effects?

How long will recovery take?

What can be done to prevent rheumatic fever from occurring again?

What is the prognosis of this condition, especially involving the heart?

Prevention

Physicians do not know how to slow the process that damages the heart valves. Therefore, preventing rheumatic fever is the most effective way to "treat" the disease.

The initial episode of rheumatic fever usually can be prevented by early treatment of streptococcal pharyngitis (strep throat) with antibiotics.