Acute Rheumatic Fever

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Overview

Inadequate treatment of a common infection called strep throat or scarlet fever, caused by the streptococcus bacteria, can lead to an inflammatory condition called Rheumatic Fever. It is most often a disease of childhood, occurring in children 5-15 years of age but can also occur in adults. Unfortunately, this disease is still prevalent mostly in the underdeveloped regions of the world.

Causes

When a person gets infected with a certain bacterium (named as Group A Streptococcus), he/she may develop a strep throat, or less commonly scarlet fever. This bacteria produce proteins that are similar to proteins normally produced by our own body, which causes our immune system to perceive normal body organs – specifically the heart, joints, skin, and the central nervous system – as foreign, and end up attacking them. This results in widespread inflammatory attacks and in an acute phase, it is termed as Acute Rheumatic Fever.

Risk factors for developing this condition include:

  • Family History
  • Type of the strep bacteria
  • Poor sanitation
  • Overcrowding

A child improperly treated or not treated at all for strep throat may be at risk for developing Rheumatic Fever.

Symptoms

Symptoms of Acute Rheumatic Fever vary with respect to duration, severity, and may change along the course of the disease. Onset of symptoms is usually two to four weeks after strep throat, and may include the following:

  • Fever
  • Pain in joints, which may migrate from one joint to another
  • Small, painless nodules under the skin
  • Heart murmurs
  • Chest pain
  • Painless rash
  • Jerky, uncontrollable body movements
  • Outbursts of unusual behaviour

Complications

In some cases, Rheumatic fever can cause some long-term complications. The most common lasting damage is that to the heart, specifically in the heart valves and the myocardium- the muscle of the heart. These conditions usually arise ten to twenty years after the initial disease.

Diagnosis

Diagnosis of Rheumatic fever depends on patient’s history, clinical physical exams, and the following tests:

  • Blood tests to check for the antibody against the bacteria, and CRP (C-Reactive Protein) and ESR (erythrocyte sedimentation rate) to assess inflammation
  • ECG (electrocardiogram) and Echocardiogram to check for heart function

Treatment

The best way to prevent Rheumatic Fever is to conduct a full antibiotic course for strep throat in an infected child. Following are some modes of treatment for ongoing rheumatic fever:

  • Antibiotics
  • Anti-inflammatory drugs
  • Corticosteroids
  • Anticonvulsant medication

Strict follow up and long term inspection for symptoms and complications is of utmost importance.

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