Rheumatic Fever

Rheumatic fever is a complication of streptococcal infection, such as strep throat or scarlet fever. It is an inflammatory disease that can occur after an infection with group A Streptococcus bacteria. The condition can affect the heart, joints, skin, and brain.

Causes and Risk Factors

Rheumatic fever is caused by an abnormal immune response to a streptococcal infection. The bacteria trigger an autoimmune response, where the body's immune system attacks its own tissues, leading to inflammation and damage. Risk factors for developing rheumatic fever include:

• Age: Rheumatic fever typically affects children between 5-15 years old
• Poor access to healthcare: Inadequate or delayed treatment of streptococcal infections increases the risk of developing rheumatic fever
• Poverty: Crowding, poor sanitation, and inadequate nutrition contribute to a higher risk of developing rheumatic fever
• Family history: Having a family member with a history of rheumatic fever or rheumatic heart disease increases the risk

Symptoms

The symptoms of rheumatic fever can vary depending on the severity of the condition and the organs affected. Common symptoms include:

• Fever: High temperature, usually above 102°F (39°C)
• Joint pain and swelling: Pain and swelling in the knees, elbows, wrists, and ankles
• Carditis: Inflammation of the heart, which can lead to symptoms such as chest pain, shortness of breath, and fatigue
• Skin manifestations: A rash or nodules under the skin, known as subcutaneous nodules
• Neurological symptoms: Sydenham's chorea, a condition characterized by involuntary movements, can occur in some cases
• Abdominal pain: Pain in the abdomen, which can be severe and may be accompanied by nausea and vomiting

Diagnosis

Diagnosing rheumatic fever involves a combination of physical examination, medical history, laboratory tests, and imaging studies. The diagnosis is based on the Jones criteria, which include:

• Major criteria: Carditis, polyarthritis, chorea, erythema marginatum (a rash), and subcutaneous nodules
• Minor criteria: Fever, arthralgia (joint pain), elevated erythrocyte sedimentation rate (ESR) or C-reactive protein (CRP), and prolonged PR interval on electrocardiogram (ECG)

Treatments

Treatment for rheumatic fever aims to reduce inflammation, eliminate the streptococcal infection, and prevent complications. The treatment plan may include:

• Antibiotics: Penicillin or other antibiotics to treat the underlying streptococcal infection
• Pain management: Medications such as acetaminophen or ibuprofen to relieve joint pain and reduce fever
• Corticosteroids: To reduce inflammation and swelling in severe cases
• Bed rest: Complete bed rest for several weeks to allow the body to recover
• Salt restriction: A low-sodium diet to reduce fluid retention and alleviate symptoms of heart failure
• Cardiac care: Monitoring and treatment of cardiac complications, such as heart failure or arrhythmias

Complications and Prognosis

Rheumatic fever can lead to serious complications, including:

• Rheumatic heart disease: Permanent damage to the heart valves, which can increase the risk of heart failure, stroke, and arrhythmias
• Heart failure: Inability of the heart to pump enough blood to meet the body's needs
• Arrhythmias: Abnormal heart rhythms, which can be life-threatening in severe cases
• Endocarditis: Infection of the inner lining of the heart, which can lead to serious complications

The prognosis for rheumatic fever depends on the severity of the condition and the promptness of treatment. With proper treatment, most people can recover from rheumatic fever without long-term consequences. However, some individuals may experience recurring episodes or develop chronic rheumatic heart disease.