What is Rheumatic Fever, Know its Symptoms, Causes, Risk Factors and Treatment

Rheumatic fever is a type of inflammatory disease that can occur in case an episode of scarlet fever or strep throat is not accurately and adequately treated. Scarlet fever or strep throat occurs when a person gets affected by an infection of streptococcus bacteria. Rheumatic fever often affects the children who are between the age group of five to fifteen years. However, even young children or older adults could get affected by this condition. However, we see that even if strep throat is a common health condition, rheumatic fever is not a frequently occurring ailment happening in the developing and the developed countries of the world.⁽¹⁾ Rheumatic fever can cause a lot of damage to the various parts of the body, more likely for the human heart.

The symptoms of rheumatic fever can vary from case to case. The person affected by rheumatic fever may have certain symptoms or can have multiple of them. The symptoms can also change and alter during the course or the progress of the disease. The onset of the fever generally occurs after two to four weeks of the throat infection. Some of the common symptoms of rheumatic fever are as follows:^(2,3,4)

• Tender and painful joints around the region of the ankles, knees, wrists, and elbows
• Fever
• Swollen, hot and red joints
• Pain in one body joint that can migrate to the other joints
• Heart murmur
• Pain in the chest
• Fatigue
• Slightly raised or even a flat painless rash
• Sydenham Chorea
• Unusual behavior like sudden cry or laugh.⁽⁵⁾

If your child has a sudden sore throat with much difficulty and pain while swallowing, fever and headache it is prudent to visit a doctor.

People who have been affected by the Group A Streptococcus and have developed a throat infection are the ones who have a higher risk of developing rheumatic fever. Such infections are often regarded as scarlet fever. However, in this context, it must be mentioned that if the skin or the other parts of the body gets affected by these bacteria, the condition does not lead to rheumatic fever. The relation between rheumatic fever and strep infection is not very clear till date. The bacteria seem to affect the immune system of the body. The strep bacteria have a protein that is similar to the one found in the body tissues. The immune system has an inherent property of attacking the bacteria and the infection causing agents.

However, due to the similarity in the nature of the proteins, the immune system often attacks the tissues of the body around the region of the heart, the skin, the joints, and the central nervous system. This reaction leads to inflammation in different parts of the body. The child must be given prompt and adequate treatment through the administration of antibiotic courses. In case, this is not done properly then the child will always have the chance of developing rheumatic fever.

Certain risk factors increase the chances of a person for being affected by the condition as compared to others. Let us take a look at them:^(1,2)

• Family History of Rheumatic Fever: In certain cases, it is seen that a family history is an element that makes a major difference. Certain genes happen to be all the more conducive to the development of rheumatic fever.
• Strain of Bacteria as a Risk Factor for Rheumatic Fever: Certain strains of the Streptococcus bacteria like Strep A are likely to bring about rheumatic fever as compared to the other strains.
• Environmental Conditions: It has been seen that rheumatic fever is a more often occurring phenomenon in places that has improper sanitation and other environmental factors.

No staple test can be used for the diagnosis of rheumatic fever. Several tests are conducted in a combination that will include physical examinations and also a detailed analysis of the medical history which together helps in the diagnosis:^(2,3)

• Swab Test to Diagnose Rheumatic Fever: Commonly it has been seen that the throat swab test is the first test that is done to ascertain whether the child is affected with the strep bacteria. If the results for this test are positive then the doctor will not prescribe any further tests for the child.
• Blood Test to Diagnose Rheumatic Fever: In certain cases, a blood test is also suggested so that the antibodies for the strep bacteria can be detected. This is done when no bacteria is detectable from the throat swab tissues.
• ECG or EKG: Rheumatic fever can affect the heart. When this test is done electrical signals are sent through the heart of the child. This is a test that can reveal much about the electrical activities of the heart of the child and tell whether it is abnormal or not. This helps the doctor to understand whether the heart has been enlarged or not due to rheumatic fever.
• Echocardiogram to Diagnose Rheumatic Fever: In this context, the sound waves are used to create images of the heart that will help the doctor to tell whether there are any abnormalities in the heart caused by rheumatic fever.

The treatment of rheumatic fever is done with multiple goals of destroying the remaining group A streptococcal bacteria, control and reduce the inflammation, relieve the symptoms, prevent the worsening of the condition and attempt for a reversal of the rheumatic fever. This is something that can be done with a blend of different types of treatment techniques. Let us take a look at them:^(2,3,5)

Antibiotics to Treat Rheumatic Fever: Administration of antibiotics is one of the main procedures of treatment that is undertaken for rheumatic fever. Penicillin is the most common form of antibiotic that is prescribed to eliminate bacteria. Long-acting penicillin can be given as an IM injection; alternatively, amoxicillin or penicillin can be given orally for 10 days.⁽⁴⁾ Once the course of the first antibiotic is completed the doctor might even offer another course of antibiotics that will be given to prevent the return or the relapse of the disease. The preventive treatment might be continued till the age of 21 or for a minimum span of five years, whichever is the first to happen.

1. Non-steroidal Anti-inflammatory Drugs for Rheumatic Fever: Often pain relievers like naproxen, aspirin is prescribed to reduce the inflammation and control the pain and the fever. However, if the child is not responding to these drugs, corticosteroids are prescribed to the child.
2. Anticonvulsant Medications to Treat Rheumatic Fever: In case the child experiences severe involuntary movements that are triggered by the condition of the Sydenham chorea, the doctor can administer anti-seizure medications like valproic acid and the carbamazepine.
3. Long Term Care for Rheumatic Fever: Rheumatic fever is a type of ailment that negatively affects the heart. Often the damage does not show up for many years. Hence, the person might need to get cardiac checkups on a regular basis.

The most important step that must be followed to keep the rheumatic fever at bay is to properly treat any strep throat infection of your child within few days of the emergence of the symptoms. This treatment must be complete and thorough. All the prescribed dozes of medicine must be covered and completed to perfection. However, if a child is affected with this health condition, it is imperative that certain proper hygiene methods are followed:^{(2, 3)}

• Wash your hands thoroughly
• Always cover your mouth while sneezing and coughing
• Do not come in close contact with people who are sick
• Do not share the personal things of the people who are affected by the condition.

Although, it is said that Rheumatic fever is a health condition that is not much heard of in the developed countries and it happens to be more conducive for the developing countries; there is no hard and fast rules establishing this fact till date. In this context, it can be said that a person who has been affected by rheumatic fever might have to face a relapse in the coming times. This could lead to a worsening of the cardiac health. This is why a regular checkup is mandatory for the person who has been affected by rheumatic fever once. A complete course medicine should be taken in order to cure streptococcal infection and to prevent rheumatic fever; however, if one is already affected by the condition, then the advised medicines should be taken without failure in order to prevent further complications and worsening of the cardiac health.

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