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Introduction
Rheumatic fever is one of the complications associated with strep throat. Its
a relatively serious illness that can cause stroke, permanent damage to your
heart, and death if its left untreated. The condition usually appears in
children between the ages of 5 and 15, even though older children and
adults have been known to contract the fever as well. Its still common in
places like sub-Saharan Africa, south central Asia, and certain populations in
Australia and New Zealand. It is a disease of poverty caused by Acute
Rheumatic Fever (ARF). Rheumatic Fever is an illness that predominantly
affects children, with the highest rates occurring in the 5-14 year age group.
Rheumatic fever causes RHD and is the most common cause of cardiac
mortality in children and adults aged less than 40 years this often disabling
disease can cause mortality. RHD is the most common cause of childhood
cardiovascular death and illness in the developing world. A minimum of 15
million people worldwide have the disease, resulting in 300,000 deaths each
year. The cause is a Streptococcal A infection.
RHD is difficult to detect in its early stages, however all children and adults
who are suspected of having ARF should have an ultrasound of the heart,
known as echocardiography. This test greatly enhances the chances of an
accurate diagnosis.
Accurate diagnosis continues to be a problematic for health clinicians, where
over-diagnosis results in unnecessary treatment over a long time, while
underdiagnosis leads to further attacks of ARF, cardiac damage and
premature death. Diagnosis remains a clinical decision, as there is no specific
laboratory test.
The risk is increased with socioeconomic disadvantage such as overcrowding
in housing, poor nutrition, poor household sanitation and wastewater
management. RHD is preventable by improving living conditions and
introducing effective measures of prevention and control. Often RHD is
called the classic disease of social injustice.
These primary infrastructure related programs can be addressed in parallel
with the medical education, intervention, prevention, support and research
programs
Causes
Symptoms
Rheumatic fever is caused by a reaction to the bacteria that causes strep
throat, group A streptococcus. Although not all cases of strep throat result in
rheumatic fever, this serious complication may be prevented with diagnosis
and treatment of strep throat. The following symptoms may be present:
a sore throat
a sore throat with tender and swollen lymph nodes
a red rash
difficulty swallowing
thick, bloody discharge from nose
a temperature of 101F or above
tonsils that are red and swollen
tonsils with white patches or pus
small, red spots on the roof of their mouth
a headache
nausea
vomiting
Complications
Once they develop, the symptoms of rheumatic fever can last for months.
Rheumatic fever can cause long-term complications in certain situations.
One of the most prevalent complications is rheumatic heart disease. Other
heart conditions include:
Diagnosis
A physical exam will be given to determine a recent bout of strep throat
which includes the following:
looking for rash or skin nodules, which are hard bumps beneath the
skin
listening to their heart to check for abnormalities
performing movement tests to determine their nervous system
dysfunction
examining their joints for inflammation
testing their blood for strep bacteria
performing an electrocardiogram, which measures the electric waves
of their heart
The first step in diagnosing rheumatic heart disease is establishing that one
recently had a strep infection. The doctor may order a throat culture, a blood
test, or both to check for the presence of strep antibodies.
The doctor will do a physical examination and check for signs of rheumatic
fever, including joint pain and inflammation. The doctor also will listen to the
heart to check for abnormal rhythms or murmurs that may signify that the
heart has been strained.
In addition, there are a couple of tests that may be used to check the heart
and assess damage, including:
Chest X-ray to check the size of the heart and to see if there is excess
fluid in the heart or lungs
Echocardiogram, a non-invasive test that uses sound waves to create a
moving image of the heart and to measure its size and shape
Treatment
Treatment will involve getting rid of all of the residual group A strep bacteria
and treating and controlling the symptoms. This can include any of the
following:
Antibiotics
The doctor will prescribe antibiotics and might prescribe a long-term
treatment to prevent it from occurring again. This treatment can last
up to five years.
Anti-Inflammatory Treatment
Anti-inflammatory treatments include pain medications that are also
anti-inflammatory, such as aspirin or naproxen. Doctors may also
prescribe a corticosteroid to reduce inflammation.
Anticonvulsant Medications
Bed Rest
Bed rest is recommended and restricted activities until the major
symptoms like pain and inflammation have passed. Strict bed rest will
be recommended for a few weeks to a few months if the fever has
caused heart problems.
Risk Factors
Factors that increase chances of developing rheumatic fever include:
Prevention
The most effective way to make sure that one doesnt develop rheumatic
fever is to treat strep throat infection quickly and thoroughly. This means
making sure one completes all prescribed doses of medication.