Rheumatic fever is a systemic illness which can occur after a throat infection with a bacteria called Streptococcus pyogenes. It’s serious illness that can cause permanent damage to the heart. Rheumatic fever is common in underdeveloped countries like Nepal. It is most common in children (5 to 15 years old) but can occur in younger children and adults as well.
Rheumatic fever usually follows a throat infection caused by a specific group of bacteria called Group A Streptococcus. The exact association between strep infection and rheumatic fever is not clear but it’s thought to be immune mediated. The streptococcal bacteria contains a protein similar to the one found in the certain tissues of the body mainly heart, joints, skin and central nervous system. Strep throat, if not treated on time or inadequately treated, the immune system cells that would normally target the bacteria; may also target the these tissues resulting in inflammation of those tissues. Rheumatic fever symptoms are mainly from the inflammation of those affected tissues.
Rheumatic fever does not affect all individuals who have had a strep throat infection.
The risk factors for rheumatic fever include:
The symptoms of the disease may vary from person to person. Some may experience a wide range of symptoms whereas some may only get a few. The symptoms usually occur about 2 to 4 weeks after the onset of strep throat infection.
The symptoms are seen from inflammation in the heart, joints, central nervous system and skin:
You should see your doctor if your child has signs and symptoms of a throat infection. You should immediately see a doctor if your child shows signs or symptoms of rheumatic fever. Diagnosis is usually based on the presence of signs and symptoms in combination with evidence of a recent streptococcal infection using the Jones criteria.
Your doctor will advise you to undergo some tests like to look for causes, make the diagnosis and detect complications:
The main goals of the treatment are:
Bed rest is enforced even if the patient feels well enough. Regular activity should not be resumed till inflammation has subsided.
Diazepam or anticonvulsant medications (valproic acid, carbamazepine) is given for chorea (abnormal jerky movements of hand, feet or face)
Primary prevention means prevention of development of rheumatic fever after a throat infection. Proper diagnosis and adequate antibiotics treatment of strep throat can prevent acute rheumatic fever in most cases.
Secondary prevention means prevention of recurrent rheumatic fever after successful treatment of first episode of rheumatic fever. A child who has had attack of rheumatic fever is at very high risk of developing recurrence after subsequent strep throat infection and needs continuous antibiotics prophylaxis to prevent such recurrences. In general continuous antibiotics are needed upto age of 25 years. If there is permanent significant damage to the heart valves , antibiotics are needed for longer duration and possibly for life long.