Rheumatic fever: causes, symptoms, diagnosis, treatment and prevention

Overview

Rheumatic fever is a condition that develops as a result of complication of untreated or inadequately treated group A streptococcal infection. The condition is characterized by inflammation in various parts of the body, particularly the heart, joints, skin, and brain. It can cause permanent damage to the affected parts, particularly the heart valves, which can lead to heart failure and death. Rheumatic fever primarily affects children between the ages of 5 and 15 years, but it can occur in individuals of any age.

Definition

Rheumatic fever is an inflammatory condition that develops as a complication of untreated or inadequately treated group A streptococcal infection. The condition can affect various parts of the body, particularly the heart, joints, skin, and brain.

Classification

Rheumatic fever is classified into two types: acute rheumatic fever (ARF) and chronic rheumatic heart disease (RHD). ARF is a short-term illness that occurs after a streptococcal infection, and usually resolves on its own within a few weeks. On the other hand, RHD is a long-term condition that can develop after recurrent episodes of ARF and can lead to permanent damage to the heart valves.

Causes

Rheumatic fever is caused by a group A streptococcal infection. The bacteria responsible for this infection are commonly found in the throat and on the skin. The infection spreads through respiratory droplets when an infected person coughs or sneezes. If left untreated or inadequately treated, the infection can lead to the development of rheumatic fever.

Causative Agent

The causative agent of rheumatic fever is group A streptococcus bacteria. These bacteria are also responsible for causing other illnesses such as strep throat, scarlet fever, and impetigo.

Mode of Transmission

The group A streptococcus bacteria responsible for rheumatic fever is transmitted through respiratory droplets. This can occur when an infected person coughs or sneezes, and another person comes into contact with the droplets.

Incubation Period

The incubation period for group A streptococcal infection is typically 2-5 days, but it can vary from 1-10 days.

Signs and Symptoms

The signs and symptoms of rheumatic fever can vary from person to person. However, some common symptoms include:

• - Fever
• - Painful and swollen joints
• - Chest pain
• - Shortness of breath
• - Fatigue
• - Skin rash
• - Jerky body movements
• - Nausea and vomiting
• - Headache
• - Abdominal pain

Diagnosis and Test

Diagnosing rheumatic fever can be challenging because the symptoms can be similar to those of other illnesses. A doctor will typically look for a combination of symptoms and other tests to confirm the diagnosis. Some of the tests that can be used to diagnose rheumatic fever include:

1. Throat culture: This test can detect the presence of group A streptococcus bacteria in the throat.
2. Blood tests: These tests can detect the presence of antibodies that the body produces in response to the streptococcal infection.
3. Electrocardiogram (ECG): This test can detect any abnormalities in the heart's electrical activity.
4. Echocardiogram: This test uses ultrasound waves to create images of the heart and can detect any damage to the heart valves.
   

Management and Treatment

The treatment of rheumatic fever typically involves a combination of antibiotics and anti-inflammatory medication. Antibiotics are used to treat the underlying streptococcal infection, while anti-inflammatory medication is used to reduce inflammation in the affected parts of the body. In severe cases, hospitalization may be required. In some cases, surgery may be necessary to repair or replace damaged heart valves.

Risk Factors

Several factors can increase the risk of developing rheumatic fever, including:

1. Age: Children between the ages of 5 and 15 years are at higher risk of developing rheumatic fever.
2. Genetics: Some people may have a genetic predisposition to developing rheumatic fever.
3. Geography: Rheumatic fever is more common in developing countries with poor living conditions and limited access to healthcare.
4. Socioeconomic status: People from lower socioeconomic backgrounds are at higher risk of developing rheumatic fever.

Prevention and Control

Preventing rheumatic fever involves prompt treatment of group A streptococcal infection with antibiotics. It is also essential to maintain good hygiene, particularly in crowded areas such as schools and daycare centers. People with a history of rheumatic fever should have regular check-ups to monitor their heart health.

Complications

Rheumatic fever can cause several complications, particularly if left untreated or inadequately treated. Some of the complications include:

1. Rheumatic heart disease: This is a long-term complication that can cause permanent damage to the heart valves, leading to heart failure and death.
2. Pericarditis: This is inflammation of the sac surrounding the heart and can cause chest pain and difficulty in breathing.
3. Sydenham chorea: This is a neurological complication that can cause jerky body movements and emotional instability.
4. Skin infections: Rheumatic fever can cause skin infections such as impetigo and cellulitis.

Conclusion

Rheumatic fever is a serious health condition that can cause permanent damage to various parts of the body, particularly the heart valves. It is caused by an untreated or inadequately treated group A streptococcal infection. Prompt treatment with antibiotics and anti-inflammatory medication can reduce the risk of complications. Good hygiene practices and regular check-ups for people with a history of rheumatic fever can also help prevent the condition.

Outcome for Infected People

The outcome for people with rheumatic fever can vary depending on the severity of the illness and the promptness and effectiveness of treatment. If treated promptly and adequately, most people with rheumatic fever will recover without any long-term complications. However, if left untreated or inadequately treated, rheumatic fever can cause permanent damage to various parts of the body, particularly the heart valves, leading to heart failure and death.

References:

• Carapetis JR, Steer AC, Mulholland EK, Weber M. The global burden of group A streptococcal diseases. Lancet Infect Dis. 2005;5(11):685-694.
• American Heart Association. Rheumatic fever. https://www.heart.org/en/health-topics/rheumatic-fever. Accessed February 25, 2023.
• World Health Organization. Rheumatic fever and rheumatic heart disease. https://www.who.int/news-room/fact-sheets/detail/rheumatic-fever-and-rheumatic-heart-disease. Accessed February 25, 2023.
• Australian Rheumatic Fever Strategy. Diagnosis, management and secondary prevention of acute rheumatic fever and rheumatic heart disease: 2012 update. https://www.health.gov.au/resources/publications/diagnosis-management-and-secondary-prevention-of-acute-rheumatic-fever-and-rheumatic-heart-disease-2012-update