Rheumatic Fever
Introduction
Rheumatic fever is an inflammatory disease that can develop as a complication of inadequately treated streptococcus throat infection, also known as strep throat. It can cause severe damage to the heart, joints, skin, and brain. Rheumatic fever primarily affects children between the ages of 5 and 15 years and can have long-term effects on the patient's health.
Etiology
Rheumatic fever is caused by an immune response to infection with group A Streptococcus bacteria. The bacteria are usually contracted through droplet transmission or direct contact with an infected person. The immune system's response to the infection can result in inflammation in various parts of the body, leading to the symptoms of rheumatic fever.
Pathophysiology
The pathophysiology of rheumatic fever involves an autoimmune response to group A streptococcal infection. The immune system mistakenly attacks the body's own tissues, thinking they are the infectious bacteria. This results in inflammation and damage to the heart, joints, skin, and brain. The most serious complication of rheumatic fever is rheumatic heart disease, which can cause permanent damage to the heart valves.
Clinical Manifestations
The symptoms of rheumatic fever usually begin 1 to 5 weeks after a strep throat infection. They may include:
- Fever
- Painful and swollen joints, most commonly in the knees, ankles, elbows, and wrists
- Involuntary, jerky movements (chorea)
- Skin rashes
- Fatigue
- Weight loss
- Shortness of breath
Diagnosis
Diagnosis of rheumatic fever is based on the presence of a combination of clinical manifestations and evidence of a recent streptococcal infection. The Jones Criteria are commonly used to diagnose rheumatic fever. They include two major criteria (carditis, polyarthritis, chorea, erythema marginatum, and subcutaneous nodules) and four minor criteria (fever, arthralgia, elevated acute phase reactants, and prolonged PR interval on EKG).
Treatment
Treatment of rheumatic fever involves eradicating the streptococcal infection, controlling symptoms, and preventing recurrences. This is usually achieved with antibiotics, anti-inflammatory treatments, and in some cases, long-term prophylaxis to prevent recurrence.
Prognosis
The prognosis of rheumatic fever depends on the severity of the symptoms and the patient's response to treatment. With appropriate treatment, most people recover completely. However, in some cases, rheumatic fever can cause long-term complications, such as rheumatic heart disease.
Prevention
Prevention of rheumatic fever involves prompt treatment of strep throat with antibiotics. This can prevent the immune response that leads to rheumatic fever. In areas where rheumatic fever is common, preventative antibiotics may also be given to close contacts of people with strep throat.
Epidemiology
Rheumatic fever is more common in developing countries and in populations with limited access to healthcare. It is also more common in children between the ages of 5 and 15, although it can occur at any age.