Last updated date: 05-Jun-2023
Originally Written in English
Acute Rheumatic Fever: Treatment and Prevention
Rheumatic fever is an inflammatory condition that can develop as a complication of untreated or inadequately treated streptococcal infections, such as strep throat or scarlet fever. It is more common in children and young adults and is more prevalent in developing countries with limited access to healthcare and antibiotics.
The bacteria responsible for streptococcal infections can trigger an autoimmune response in the body, leading to inflammation and damage to the heart valves, joints, skin, and nervous system. Prompt and adequate treatment of streptococcal infections with antibiotics is crucial to prevent the development of rheumatic fever.
What is Rheumatic Fever?
Rheumatic fever is a serious inflammatory disease that can develop as a complication of untreated or inadequately treated strep throat or scarlet fever. It mainly affects children aged between 5 and 15, and can damage the heart, joints, skin, and nervous system.
Rheumatic fever occurs when the body's immune system mistakenly attacks healthy tissues, particularly the heart valves, leading to scarring and narrowing of the valves. This can cause problems with blood flow, leading to conditions like rheumatic heart disease, which can be life-threatening.
How common is Rheumatic Fever?
Rheumatic fever is relatively uncommon in developed countries where access to healthcare and antibiotics is widespread. However, it remains a significant public health problem in developing countries with poor sanitation and limited access to healthcare.
According to the World Health Organization (WHO), an estimated 33 million people worldwide are affected by rheumatic heart disease, which is often caused by untreated or inadequately treated rheumatic fever. Most of these cases are concentrated in low- and middle-income countries, particularly in sub-Saharan Africa, South Asia, and the Pacific.
In developed countries, the incidence of rheumatic fever has decreased significantly over the past century due to improved hygiene, living conditions, and access to antibiotics. However, it still occurs, particularly in populations with poor access to healthcare or in communities with overcrowding and poor sanitation. The incidence is highest among children aged 5-15 years, and it is more common in certain ethnic groups, such as Indigenous populations.
What causes Rheumatic Fever?
Rheumatic fever is caused by an untreated or inadequately treated streptococcal infection. Streptococcal bacteria are responsible for various infections, such as strep throat and scarlet fever. If these infections are not treated adequately with antibiotics, the bacteria can trigger an autoimmune response in the body, leading to rheumatic fever.
The exact mechanisms of how the bacteria cause the autoimmune response in the body are not yet fully understood. However, it is believed that the bacterial proteins share some similarities with certain proteins found in the body, particularly in the heart, joints, and other organs. This similarity can confuse the body's immune system, leading it to mistakenly attack its own tissues, causing inflammation, and damage.
Rheumatic fever is more common in children and young adults, and it is more prevalent in developing countries with limited access to healthcare and antibiotics. It can lead to permanent damage to the heart valves, which can cause lifelong complications, such as heart failure, and even death.
Prompt and adequate treatment of streptococcal infections with antibiotics is crucial to prevent the development of rheumatic fever. Additionally, good hygiene practices, such as frequent hand washing, covering the mouth and nose when coughing or sneezing, and avoiding close contact with sick people, can help prevent the spread of streptococcal infections.
Who’s at risk for Rheumatic Fever?
Anyone can develop rheumatic fever, but it is most common in children aged 5 to 15 years old. Certain factors may increase the risk of developing rheumatic fever, including:
- Genetics: There may be a genetic predisposition to developing rheumatic fever, as some individuals may have an inherited susceptibility to the strep bacteria or to an abnormal immune response.
- Environmental factors: Living in overcrowded or unsanitary conditions may increase the risk of developing strep throat, which can lead to rheumatic fever.
- Delayed or inadequate treatment of strep throat: Failing to promptly treat a strep throat infection with antibiotics can increase the risk of developing rheumatic fever.
- Repeated strep infections: Multiple episodes of strep throat or scarlet fever can increase the risk of developing rheumatic fever.
- Age and gender: Rheumatic fever is more common in children and young adults, and females are more likely to develop the disease than males.
- Geographic location: Rheumatic fever is more common in developing countries with poor living conditions and limited access to healthcare, but it can also occur in developed countries.
Is Rheumatic Fever contagious?
Rheumatic fever itself is not contagious, but the strep throat or scarlet fever infection that can lead to rheumatic fever is highly contagious. Strep throat is caused by group A streptococcus bacteria, which can be spread from person to person through respiratory droplets when an infected person talks, coughs, or sneezes. Scarlet fever is a form of strep throat that also produces a skin rash.
It is important to treat strep throat or scarlet fever with antibiotics to prevent the development of rheumatic fever. Prompt treatment can also reduce the spread of the infection to others. Additionally, good hygiene practices, such as washing hands regularly and avoiding close contact with people who are sick, can help reduce the spread of the infection.
What are the symptoms of Rheumatic Fever?
The symptoms of rheumatic fever can vary depending on the severity of the disease and the affected organs.
The symptoms typically appear 2-4 weeks after a strep throat infection and may include:
- Fever: A high fever, usually above 101°F (38.3°C), is one of the hallmark symptoms of rheumatic fever.
- Joint pain: Pain, swelling, and redness of the joints, especially the knees, ankles, elbows, and wrists, is a common symptom.
- Skin rash: A flat, painless rash with a "lace-like" appearance may develop on the trunk, arms, and legs.
- Jerky, involuntary movements: Uncontrolled movements of the face, arms, and legs, known as Sydenham's chorea, can occur in some cases.
- Chest pain: Chest pain or discomfort, especially with breathing or coughing, may occur due to inflammation of the heart lining or muscles.
- Shortness of breath: Difficulty breathing or shortness of breath may occur due to heart or lung involvement.
- Fatigue: A feeling of tiredness or lack of energy is common with rheumatic fever.
Other symptoms may include abdominal pain, nosebleeds, and headache. It is important to note that not all individuals with rheumatic fever will experience all of these symptoms, and some may have mild or no symptoms at all. If you or someone you know has had a recent strep throat infection and develops any of these symptoms, it is important to seek medical attention immediately. Early diagnosis and treatment can help prevent complications and long-term damage.
How is Rheumatic Fever diagnosed?
The diagnosis of rheumatic fever usually involves a combination of clinical evaluation, medical history, and laboratory tests. The following are some of the common methods used to diagnose rheumatic fever:
- Physical examination: The doctor will perform a physical exam to check for signs and symptoms of rheumatic fever, such as joint swelling, redness, and warmth, skin rash, and jerky, involuntary movements of the limbs.
- Medical history: The doctor will ask about the patient's medical history, including any recent infections or exposure to strep throat or scarlet fever.
- Blood tests: Blood tests can help detect the presence of antibodies to streptococcus bacteria and other markers of inflammation.
- Throat culture: A throat culture may be performed to test for the presence of strep bacteria.
- Electrocardiogram (ECG): An ECG is a test that records the electrical activity of the heart and can detect any abnormalities in heart rhythm or function.
- Echocardiogram: An echocardiogram is a type of ultrasound that uses sound waves to create images of the heart. It can detect any damage to the heart valves and assess the overall function of the heart.
To diagnose rheumatic fever, the patient must meet certain criteria established by the American Heart Association, which include the presence of two major criteria or one major and two minor criteria, along with evidence of a recent strep infection. The criteria include various signs and symptoms, such as fever, joint pain, and heart inflammation, as well as laboratory and imaging findings.
What is Rheumatic Heart Disease?
Rheumatic heart disease is a condition that develops as a complication of rheumatic fever, a serious inflammatory disease that can occur after a streptococcal infection, such as strep throat or scarlet fever. Rheumatic heart disease occurs when rheumatic fever damages the heart valves, which are responsible for regulating blood flow through the heart.
The inflammation caused by rheumatic fever can cause scarring and thickening of the heart valves, leading to valve dysfunction. This can result in conditions such as stenosis (narrowing of the valve), regurgitation (leaking of blood through the valve), or a combination of both.
Symptoms of rheumatic heart disease may include shortness of breath, fatigue, chest pain, palpitations, and swelling of the feet and ankles. If left untreated, rheumatic heart disease can cause heart failure, arrhythmias, and other serious complications.
Diagnosis of rheumatic heart disease typically involves a physical exam, echocardiogram, and other imaging tests to evaluate the structure and function of the heart valves. Treatment may involve medications to manage symptoms and prevent complications, such as diuretics, blood thinners, and antibiotics to prevent recurrent strep infections. In severe cases, surgery may be necessary to repair or replace damaged heart valves.
How is Rheumatic Fever treated?
The treatment of rheumatic fever depends on the severity of the symptoms and the presence of complications. The primary goals of treatment are to eliminate the streptococcal infection, control inflammation, and prevent further damage to the heart and other organs. Treatment typically involves a combination of antibiotics, anti-inflammatory medications, and supportive care.
- Antibiotics: Antibiotics are used to eliminate the streptococcal infection and prevent further complications. A single injection of benzathine penicillin G is the preferred antibiotic for the treatment of strep throat and for the prevention of recurrent strep infections that can lead to rheumatic fever.
- Anti-inflammatory medications: Anti-inflammatory medications, such as aspirin or nonsteroidal anti-inflammatory drugs (NSAIDs), can help relieve pain, reduce fever, and control inflammation. Corticosteroids may also be used in severe cases to reduce inflammation and prevent damage to the heart and other organs.
- Supportive care: Supportive care may include bed rest, increased fluid intake, and monitoring for signs of heart failure or other complications.
- Long-term management: Long-term management of rheumatic fever may include ongoing treatment with antibiotics to prevent recurrent strep infections, regular monitoring of the heart and other organs, and lifestyle changes to reduce the risk of complications.
In some cases, surgery may be necessary to repair or replace damaged heart valves or to treat other complications of rheumatic fever. It is important to follow your doctor's recommendations for ongoing care and treatment to prevent complications and improve outcomes.
What complications are associated with Rheumatic Fever?
Rheumatic fever can lead to a number of serious complications if left untreated or if treatment is delayed. The following are some of the potential complications associated with rheumatic fever:
- Rheumatic heart disease: This is the most common and serious complication of rheumatic fever. It can cause permanent damage to the heart valves, leading to problems such as heart failure, arrhythmias, and stroke.
- Joint problems: Rheumatic fever can cause painful and swollen joints, particularly in the knees, ankles, elbows, and wrists. These symptoms are usually temporary but can recur with subsequent bouts of the disease.
- Skin problems: A characteristic rash called erythema marginatum can appear on the skin in some cases of rheumatic fever. Other skin problems, such as nodules and subcutaneous bumps, can also develop.
- Sydenham chorea: This is a rare complication of rheumatic fever that affects the nervous system, causing involuntary muscle movements and jerking motions.
- Inflammation of other organs: Rheumatic fever can cause inflammation of other organs such as the brain, liver, and spleen.
- Endocarditis: This is an infection of the heart lining or valves that can occur as a result of damage caused by rheumatic fever.
How can I prevent rheumatic fever?
Rheumatic fever is caused by a bacterial infection, specifically group A streptococcus bacteria, which is the same bacteria that causes strep throat. Therefore, the best way to prevent rheumatic fever is to prevent the initial strep infection. Here are some ways to prevent rheumatic fever:
- Promptly treat strep throat: If you or your child develop symptoms of strep throat, such as sore throat, fever, and swollen glands, seek medical attention right away. If the infection is confirmed, take the full course of prescribed antibiotics to ensure the bacteria are eliminated from your system.
- Practice good hygiene: Wash your hands frequently, especially after being in close contact with someone who has a strep infection. Don't share utensils, cups, or other personal items with someone who has a strep infection.
- Keep your home and workplace clean: Regularly clean surfaces that are frequently touched, such as doorknobs, phones, and keyboards, to prevent the spread of bacteria.
- Get a strep test: If you have a family history of rheumatic fever or have had it before, consider getting a throat culture or rapid strep test done if you develop symptoms of a sore throat.
- Consider preventive antibiotics: If you have a history of rheumatic fever, your doctor may recommend that you take antibiotics to prevent a strep infection.
What’s the outlook for people with Rheumatic Fever?
The outlook for people with rheumatic fever varies depending on the severity of the disease and whether it has led to any complications. With prompt and appropriate treatment, most people with rheumatic fever can recover fully and avoid long-term complications.
Antibiotics are used to treat the underlying strep infection, while anti-inflammatory medications such as aspirin and corticosteroids are used to reduce inflammation and relieve symptoms. In some cases, medications may be required long-term to prevent further inflammation and damage to the heart and other organs.
It is important for people with rheumatic fever to have regular follow-up care with a healthcare provider to monitor their heart and other organ function. They may need periodic echocardiograms and other tests to check for signs of heart valve damage or other complications.
In some cases, rheumatic fever can lead to permanent heart damage, which can increase the risk of heart failure, stroke, and other complications later in life. However, with appropriate treatment and regular follow-up care, the risk of these long-term complications can be greatly reduced.
Can Rheumatic Fever come back?
Yes, rheumatic fever can come back, especially if the underlying cause, which is an untreated or inadequately treated streptococcal infection, is not addressed. Rheumatic fever is an autoimmune disease that can occur as a complication of untreated or inadequately treated strep throat or scarlet fever. The condition can cause damage to the heart, joints, skin, and nervous system.
Once a person has had rheumatic fever, they are at a higher risk of developing it again if they are reinfected with streptococcal bacteria. Therefore, it is essential to promptly and adequately treat strep throat with antibiotics to prevent the development of rheumatic fever or its recurrence.
Additionally, people who have had rheumatic fever in the past may need to take antibiotics on a long-term basis to prevent further streptococcal infections and reduce the risk of recurrent rheumatic fever. It is important to discuss any concerns about the recurrence of rheumatic fever with a healthcare provider, who can provide guidance on appropriate prevention and management strategies.
In conclusion, rheumatic fever is an autoimmune disease that can occur as a complication of untreated or inadequately treated strep throat or scarlet fever. It can cause damage to the heart, joints, skin, and nervous system. Rheumatic fever can come back, especially if the underlying cause, which is an untreated or inadequately treated streptococcal infection, is not addressed. Therefore, it is important to promptly and adequately treat strep throat with antibiotics to prevent the development of rheumatic fever or its recurrence. Additionally, people who have had rheumatic fever in the past may need to take antibiotics on a long-term basis to prevent further streptococcal infections and reduce the risk of recurrent rheumatic fever.