Definition This is an immune response that occurs in the body, causing inflammation and damage to certain organs, particularly the heart. It follows a streptococcal infection, such as strep throat or scarlet fever.
What is going on in the body? When a person is infected with certain types of streptococcus and is not treated with antibiotics, diseases of the heart, joints, brain, and skin can occur. This was very common in Australia before antibiotics were available to treat infections.
What are the signs and symptoms of the disease? Signs and symptoms of rheumatic fever include:
fever
joint pain
joint swelling
bloody noses
abdominal pain
vomiting
rashes
skin nodules
unusual jerky movements
muscle pain
confusion
weakness and fatigue
What are the causes and risks of the disease? Risk factors include streptococcus A, the bacteria that causes strep throat and scarlet fever.
What can be done to prevent the disease? Today the treatment of strep infections with antibiotics can reduce the development of rheumatic fever.
How is the disease diagnosed? To diagnose rheumatic fever a doctor will examine the person who has the symptoms listed above. The doctor will also order several diagnostic tests. These tests include a throat culture and blood tests. An electrocardiogram (ECG) will be performed to check the heart. A chest x-ray will be taken. An echocardiogram (ultrasound) is also a very useful test.
What are the long-term effects of the disease? There are many possible complications as a result of rheumatic fever. They can include the following.
endocarditis (en-dough-car-die-tis), an inflammation of the lining of the heart
heart failure
arrhythmias or abnormal heart rhythms
pericarditis (perry-car-die-tis), an inflammation of the sac surrounding the heart
skin disorders
anaemia
proteinuria, a loss of protein in the urine
Sydenham's chorea, a nervous system disorder
What are the risks to others? Streptococcal infections are contagious. They should be treated promptly with antibiotics. There are many different types of streptococcal infections. Many of these do not cause rheumatic fever. However, some can cause kidney problems and other complications if not treated.
What are the treatments for the disease? A person with strep throat will be given antibiotics such as penicillin and erythromycin. Anti-inflammatory drugs, such as ibuprofen, can also be used as well as pain relievers, such as aspirin or paracetamol, to relieve pain and fever. However, aspirin should not be used by children because of the risk for developing Reyes syndrome.
A person with rheumatic fever will also be given antibiotics as well as anti-inflammatories and pain relievers. Bed rest is required for someone with rheumatic fever. After this, a slow increase in physical activity is allowed. Fluids are also needed. Once a person with rheumatic fever develops complications, the complications are treated on a case-by-case basis.
What are the side effects of the treatments?
Antibiotics can sometimes cause stomach upset, nausea, and diarrhoea.
Antibiotics may also cause allergic reactions.
How is the disease monitored? A doctor will monitor a person for the complications of rheumatic fever. This may require repeated echocardiograms to check the heart valves. There may also be repeated urine tests to check for protein in the urine. The doctor will also monitor the side effects of any medications used.
Author: James Broomfield, MD Reviewer: HealthAnswers Australia Medical Review Panel Editor: Dr David Taylor, Chief Medical Officer HealthAnswers Australia Last Updated: 1/10/2001 Contributors Potential conflict of interest information for reviewers available on request
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