is an inflammatory
Disease which may develop after a
Group A Streptococcal Infection (such as
Strep Throat or
Scarlet Fever ) and can involve the
Heart ,
Joint s,
Skin , and
Brain .
Rheumatic fever is common worldwide and is responsible for many cases of damaged
Heart Valve s. In the Western countries, it became fairly rare since the 1950's, possibly due to higher hygienic standards. While it is far less common in the
United States since the beginning of the
20th Century , there have been a few outbreaks since the
1980s . Although the disease seldom occurs, it is serious and has a mortality of 2 - 5%.
Rheumatic fever primarily affects children between ages six and 15 and occurs approximately 20 days after strep throat or scarlet fever. In up to a third of cases, the underlying strep infection may not have caused any symptoms.
The rate of development of rheumatic fever in individuals with untreated strep infection is estimated to be 3 %. The rate of development is far lower in individuals who have received antibiotic treatment. Persons who have suffered a case of rheumatic fever have a tendency to develop flare-ups with repeated strep infections.
The recurrence of rheumatic fever is relatively common in the absence of maintenance of low dose antibiotics, especially during the first three to five years after the first episode of rheumatic fever. Heart complications may be long-term and severe, particularly if the heart valves are involved.
T. Duckett Jones, MD first published these criteria in 1944. They have been periodically revised by the
American Heart Association in collaboration with other groups. , when there is also evidence of a previous strep infection support the diagnosis of rheumatic fever.
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- inflammation of the Heart muscle which can manifest as Congestive Heart Failure with shortness of breath, Pericarditis with a rub, or a new Heart Murmur .
- a temporary migrating inflammation of the large joints, usually starting in the legs and migrating upwards.
- a characteristic series of rapid movements without purpose of the face and arms. This can occur very late in the disease.
- '''s and spread outward to form a snakelike ring while clearing in the middle. This rash never starts on the face and is made worse with heat.
- painless, firm collections of collagen fibers on the back of the wrist, the outside elbow, and the front of the knees. These now occur infrequently.
Rheumatic fever is an
Autoimmune Disease which occurs after an untreated
Group A Streptococcal Infection , typically a
Throat Infection . The
Antibodies formed against the
Bacteria attack parts of the body, typically the joints and the heart. This occurs because the streptoccal M antigen can stimulate B cells which are cross reactive with cardiac myosin.
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Group A
Streptococcus Pyogenes has a
Cell Wall that is composed of branched
Polymers which sometimes contain "''M proteins''" which are highly
Antigenic . The antibodies formed against these proteins sometimes cross-react with normal tissue causing damage. Depending on the site of damage, this can lead to the clinical symptoms described above.
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The management of acute rheumatic fever is geared toward the reduction of inflammation with
Anti-inflammatory Medication s such as
Aspirin or
Corticosteroid s. Individuals with positive cultures for strep throat should also be treated with
Antibiotic s. Another important cornerstone in treating rheumatic fever includes the continuous use of low dose antibiotics (such as
Penicillin ,
Sulfadiazine , or
Erythromycin ) to prevent recurrence.
Patients with positive cultures for
Streptococcus Pyogenes should be treated with
Penicillin as long as
Allergy is not present. This treatment will not alter the course of the acute disease.
Patients with significant symptoms may require
Corticosteroids .
Salicylates are useful for pain.
Some patients develop significant ,
Digoxin , etcetera. Unlike normal heart failure, rheumatic heart failure responds well to
Corticosteroids .
Prevention of recurrence is achieved by eradicating the acute infection and
Prophylaxis with antibiotics. The
American Heart Association recommends
Prophylaxis continue at least 10 years.
