Rheumatic Fever

Rheumatic Fever

Rheumatic fever causes inflammation of the heart, joints, skin or brain. The disease occurs as a result of untreated bacterial infection with group A streptococci.

What is rheumatic fever?

Rheumatic fever, also known as streptococcal rheumatism , is a secondary disease of an infection of the upper airways that has become rare in our latitudes.

The disease occurs mainly in childhood. The damage often only becomes apparent decades later. The symptoms of rheumatic fever appear a few weeks after surviving a sore throat and are expressed in high fever and pain and swelling in the knee, ankle or elbow joints. For menkes syndrome guide, please visit deluxesurveillance.com.

A reddish rash also indicates rheumatic fever. Inflammation of the conjunctiva or tendon sheaths can also occur. If the heart muscle is affected, chest pain and shortness of breath occur.

Causes

Rheumatic fever is caused by a streptococcal infection, which occurs as a late consequence of a sore throat. The tissue damage occurs due to an exaggerated defense reaction of the body’s own immune system.

The antibodies produced by the body react with its own body cells. A few decades ago, the disease was relatively widespread. Many older people suffer from mitral valve stenosis as a result of childhood infection. The narrowing of the mitral valve reduces blood flow in the heart. Those affected suffer from fatigue, shortness of breath and palpitations.

The disease is still widespread in developing countries today. Inferior nutrition, a concentration of many people in a small space and untreated throat and tonsillitis promote the occurrence of rheumatic fever.

Symptoms, Ailments & Signs

The symptoms of rheumatic fever can affect several areas. Discomfort can occur in the skin, joints, heart or brain. It often begins with a flu-like condition. Patients suffer from fever and general weakness. Abdominal pain is common in children.

Various symptoms are possible on the skin. Erythema nodosum occurs relatively often on the lower leg. These are inflamed and painful red patches with nodules that form on the shinbone. They look like bruises. It is also possible for skin spots to appear on the abdomen and back.

In addition, so-called rheumatoid nodules can form on the arms and legs. Arthritis in the large joints is another symptom. It usually begins symmetrically in the knee and ankle joints, then spreads to other joints and causes severe pain. If the heart is affected, either the heart muscle tissue (myocardium) or the inner lining of the heart (endocardium) becomes inflamed.

This can lead to dysfunction of the heart valves, arrhythmias or tachycardia. The death of microscopically small tissue particles or the formation of so-called Aschoff nodes in the heart muscle are also possible. When listening, this is noticeable in changed heart sounds. Finally, encephalitis can develop in the brain, which manifests as apathy, anxiety, and random, involuntary movements (Sydenham’s chorea).

Diagnosis & History

In adults, rheumatic fever is difficult to diagnose because the clinical picture is rather atypical. A physical examination is necessary. If rheumatic fever is suspected, a throat swab is taken and examined for streptococci.

An X-ray of the chest makes it clear whether the heart has enlarged as a result of the inflammation. With the help of echocardiography, the heart valves and the inside of the heart can be visualized using ultrasound. The doctor will order a blood draw. In the case of an existing infection, the laboratory values ​​show an increased level of leukocytes and an increased number of antibodies against streptococci.

The Jones criteria published by the American Heart Association in 1992 are used to diagnose rheumatic fever. The course of the disease begins with tonsillitis or pharyngitis, which has not been treated. This is followed by one to three symptom-free weeks.

This is followed by rheumatic fever, which lasts up to twelve weeks. The disease is very protracted. If the heart valves are inflamed, scarring can occur years later. Around half of all patients develop chronic rheumatic heart disease.

Complications

Rheumatic fever primarily causes malfunctions in the heart valves. The disease is the most common cause of permanent heart disease such as heart valve inflammation and, in the further course, heart failure. In the classic form, which usually occurs in childhood, inflammation of the inner lining of the heart is possible.

If the course is severe, cardiac arrest and the death of the patient can occur. The joints, which become inflamed, swell and cause severe pain, are usually also affected. In general, rheumatic endocarditis is accompanied by severe physical discomfort. The affected person usually suffers from chronic pain, sweating and high fever – each of these symptoms is associated with further complications.

In the long term, the disease affects mental well-being and can promote conditions such as depression or anxiety disorders. Treatment with the antibiotic drug penicillin can cause skin rashes, nausea and vomiting, and loss of appetite. Inflammation of the mucous membranes, dry mouth and impairment of the sense of taste often occur.

Occasionally also anemia and temporary liver dysfunction. Acetylsalicylic acid, used to reduce inflammation, can cause heartburn, dizziness and gastrointestinal bleeding, among other things. The use of cortisone and immunosuppressants can also trigger a number of side effects.

When should you go to the doctor?

If fever, rash, and joint pain occur, rheumatic fever may be the underlying cause. A doctor’s visit is recommended if the symptoms persist after a day or two. If other signs of illness occur, such as chest pain or the typical jerky movements, you should consult a doctor. Rheumatic fever usually occurs in connection with a streptococcal infection. Children between the ages of five and fifteen also belong to the risk groups and should be treated by a doctor if the symptoms mentioned occur.

Other favorable factors are unhygienic living conditions and an unbalanced diet. Rheumatic fever is treated by the general practitioner or an internist. If there are any skin changes, the dermatologist is the right contact person. If the condition is treated during the initial inflammation of the throat, rheumatic fever can often be averted. However, heart damage that has already occurred can no longer be repaired and also increases the risk of further flare-ups. Therefore, if you have a severe sore throat with fever and joint pain, you should see your general practitioner or pediatrician immediatelybecome involved. The doctor can carry out a rapid streptococcal test and thus make the diagnosis quickly.

Treatment & Therapy

The patient is prescribed strict bed rest for about a fortnight. Drug treatment is started immediately. Penicillin is given to kill the streptococci and should be given over a period of ten days.

If there is an allergy to penicillin, macrolides are given. Anti-inflammatory drugs reduce fever and relieve joint inflammation. Common active ingredients here are ibuprofen, indomethacin or piroxicam. Corticosteroids are prescribed for heart inflammation. These active ingredients are similar to the body’s own hormones.

Inflammation is reduced by inhibiting the formation of the natural substances that ultimately cause inflammation. At this point, cortisone, prednisolone or dexamethasone should be mentioned. The duration of drug treatment depends on the severity of the disease.

As a rule, the drugs are prescribed up to the age of 21 or up to five years after the last onset of rheumatic fever. In severe cases, drug treatment is recommended up to ten years after the onset of rheumatic fever.

Prevention

Since sore throats have been treated with antibiotics, the occurrence of rheumatic fever has become a rarity in western industrialized countries. Preventively, febrile diseases of the upper respiratory tract should not be taken lightly. The doctor will decide to what extent the administration of antibiotics is necessary. Rheumatic fever can be prevented from coming back by taking low doses of antibiotics for several years after the disease was last seen.

Aftercare

In general, after the disease has subsided, long-term therapy with monthly, intramuscularly administered benzathine penicillin is carried out as follow-up treatment up to the age of 25; alternatively, however, penicillin can also be administered orally. If the heart or joints are still impaired, rehabilitation in the form of physiotherapy is also recommended.

In any case, regular cardiological examinations are prescribed. In general, children and young adults with healed rheumatic fever are at high risk of recurrence (recurrence) in the next five years or for life. Any subsequent streptococcal upper respiratory tract disease could develop carditis; without further follow-up care, the risk is even 20 percent.

Therefore, depending on whether they already had rheumatic fever with or without carditis, they are given antibiotic prophylaxis for five (without carditis) to ten years (with carditis) after the end of therapy. In the case of a permanent heart valve defect, antibiotic follow-up treatment is sometimes prescribed until the age of 40 or sometimes for life.

In the case of surgical interventions, endocarditis prophylaxis should also be administered. For environmental prophylaxis, it is recommended that all family members of the affected person take a throat swab to verify group A streptococci. If this is positive, the affected family members are also prescribed antibiotic treatment.

You can do that yourself

This disease, which has become rare in Germany, belongs in the hands of general practitioners and pediatricians or internists. If the skin is affected, patients should also consult a dermatologist.

When diagnosed with rheumatic fever, it is extremely important for patients to take the medication prescribed by doctors, otherwise it can irreparably damage the heart or even be fatal. The prescribed bed rest must also be observed. Because most of those affected are children, the parents must pay close attention to following the doctor’s instructions. This may be complicated by the fact that the drugs commonly used for treatment can cause severe side effects that prevent compliance. However, children in particular have to take the medication over a longer period of time, usually up to the age of 21.

Since the disease is the result of a streptococcal infection, hygienic measures are often required. This includes cleaning the environment, because the bacteria are on uncleaned surfaces, taps and door handles. Food can also contain streptococci. Therefore, in a household where a patient suffers from rheumatic fever, food should be thoroughly washed before use. Incidentally, the same applies to the hands of all family members. Frequent washing can prevent contamination and reinfection.

Rheumatic Fever