Summary about Disease
Rheumatic fever (RF) is a serious inflammatory condition that can develop as a complication of inadequately treated strep throat or scarlet fever. These infections are caused by bacteria called Streptococcus pyogenes (group A streptococcus). Rheumatic fever primarily affects children and adolescents but can affect adults as well. It can damage the heart, joints, brain, and skin. Repeated episodes of RF can lead to rheumatic heart disease, a chronic condition that can cause permanent heart damage, including damaged heart valves.
Symptoms
Symptoms typically appear 1-5 weeks after a strep throat infection. Common symptoms include:
Fever: Elevated body temperature.
Painful and Tender Joints: Most often affects the knees, ankles, elbows, and wrists. The pain may migrate from one joint to another.
Inflammation of the Joints: Joints are often red, hot, and swollen.
Nodules Under the Skin: Small, painless bumps may develop under the skin, usually over bony prominences.
Skin Rash (Erythema Marginatum): A flat or slightly raised rash with a pink border and a clear center. This rash is usually painless and appears on the trunk and limbs.
Jerky, Uncontrollable Body Movements (Sydenham's Chorea): Characterized by rapid, irregular, and aimless movements, especially of the face, hands, and feet. This can occur months after the initial strep infection.
Shortness of Breath: Indicative of heart involvement (carditis).
Chest Pain: Indicative of heart involvement (carditis).
Heart Murmur: An abnormal sound heard during a heartbeat, which can indicate valve damage.
Fatigue: Feeling unusually tired or weak.
Stomach Pain
Causes
Rheumatic fever is caused by the body's immune response to a strep throat or scarlet fever infection. It is not the strep bacteria itself that directly causes the damage. Instead, the body's immune system mistakenly attacks its own tissues after fighting off the strep infection. Specifically, antibodies produced to fight the strep bacteria can cross-react with tissues in the heart, joints, brain, and skin, leading to inflammation and damage. Incomplete or absent treatment of strep throat or scarlet fever with antibiotics is a significant risk factor.
Medicine Used
Antibiotics: Penicillin or amoxicillin is used to eliminate any remaining strep bacteria. For those allergic to penicillin, erythromycin or another suitable antibiotic can be used.
Anti-inflammatory Medications: Aspirin, ibuprofen, or naproxen are used to reduce inflammation and pain, particularly in the joints. Corticosteroids (such as prednisone) may be used for severe cases of carditis.
Anticonvulsants: For Sydenham's chorea, medications like haloperidol or valproic acid may be used to control the involuntary movements.
Diuretics: If heart failure develops, diuretics may be used to reduce fluid buildup.
Is Communicable
Rheumatic fever itself is not communicable. It is a non-contagious autoimmune reaction to a strep infection. However, the underlying strep throat infection is communicable. Strep throat spreads through respiratory droplets produced when an infected person coughs or sneezes, or through direct contact with infected sores.
Precautions
Prompt Treatment of Strep Throat: The most important precaution is to ensure that strep throat and scarlet fever are promptly and completely treated with antibiotics.
Completing Antibiotic Courses: Take the full course of antibiotics prescribed by a doctor, even if you start feeling better.
Good Hygiene: Practice good hygiene habits, such as frequent handwashing, to prevent the spread of strep infections.
Avoid Sharing Personal Items: Do not share eating utensils, cups, or other personal items with someone who has a strep infection.
Prophylactic Antibiotics: Individuals who have had rheumatic fever may need to take long-term prophylactic antibiotics (usually penicillin) to prevent recurrent strep infections and subsequent episodes of rheumatic fever. This is particularly important if they have developed rheumatic heart disease.
How long does an outbreak last?
Rheumatic fever itself is not an "outbreak" disease like measles or influenza. It is a complication of strep throat. The acute symptoms of rheumatic fever, if untreated, can last for several weeks to months. However, the long-term effects, particularly rheumatic heart disease, can be lifelong. The duration of symptoms is highly variable and depends on the severity of the inflammation and the specific organs affected.
How is it diagnosed?
Diagnosis of rheumatic fever is based on a combination of factors, including:
Medical History: Review of the patient's history for recent strep throat infection.
Physical Examination: Assessment for symptoms such as joint pain, rash, heart murmur, and involuntary movements.
Jones Criteria: The revised Jones criteria are a set of guidelines used to diagnose rheumatic fever. These criteria include major and minor manifestations, along with evidence of a preceding Group A streptococcal infection.
Evidence of Prior Strep Infection: Confirmed by throat culture, rapid strep test, or elevated or rising streptococcal antibody titers (e.g., antistreptolysin O (ASO) titer, anti-DNase B).
Major Manifestations: Carditis, polyarthritis, chorea, erythema marginatum, subcutaneous nodules.
Minor Manifestations: Fever, arthralgia (joint pain without inflammation), elevated erythrocyte sedimentation rate (ESR) or C-reactive protein (CRP), prolonged PR interval on electrocardiogram (ECG).
Echocardiogram: Used to assess the heart for valve damage or other signs of carditis.
Electrocardiogram (ECG): To look for heart rhythm abnormalities or prolonged PR interval.
Blood Tests: To detect evidence of a recent strep infection (e.g., ASO titer, anti-DNase B) and to measure inflammatory markers (ESR, CRP).
Timeline of Symptoms
Strep Throat Infection: Initial strep throat symptoms (sore throat, fever, headache) typically appear 1-5 days after exposure to the strep bacteria.
Latent Period: A symptom-free period of 1-5 weeks follows the strep throat infection.
Onset of Rheumatic Fever Symptoms: Symptoms of rheumatic fever usually begin 1-5 weeks after the untreated or inadequately treated strep throat.
Course of Symptoms:
Acute Phase: Joint pain and inflammation are often the first symptoms. Fever, rash, and carditis may develop soon after.
Sydenham's Chorea: This symptom often appears later, sometimes several months after the initial strep infection and other symptoms of rheumatic fever have subsided.
Resolution: With treatment, most symptoms resolve within a few weeks to a few months. However, carditis can lead to long-term heart damage.
Long-term Prophylaxis: After an episode of RF, long-term antibiotics are prescribed to prevent future strep infections
Important Considerations
Rheumatic Heart Disease: The most serious complication of rheumatic fever is rheumatic heart disease, which can cause permanent damage to the heart valves, leading to heart failure, stroke, and other cardiovascular problems.
Recurrence: Individuals who have had rheumatic fever are at increased risk of recurrent episodes if they contract another strep infection. Therefore, prophylactic antibiotics are crucial.
Prevention: Primary prevention through prompt treatment of strep throat is key to preventing rheumatic fever.
Socioeconomic Factors: Rheumatic fever is more common in low-income countries and communities with poor sanitation and overcrowding, contributing to the spread of strep infections.
Early Diagnosis and Treatment: Early diagnosis and treatment of both strep throat and rheumatic fever are essential to prevent long-term complications.
Monitoring: Individuals with rheumatic heart disease require regular monitoring by a cardiologist to assess the severity of valve damage and to manage symptoms.
Pregnancy: Women with rheumatic heart disease require careful monitoring during pregnancy due to the increased stress on the heart.
Dental Procedures: Individuals with rheumatic heart disease may require antibiotics before certain dental procedures to prevent endocarditis (infection of the heart valves).