Rheumatic fever

 

Acute rheumatic fever (ARF) is an autoimmune reaction that occurs post the infection with Lancefield group A ß-hemolytic streptococci. It is commonly found in areas where the standard of hygiene is low and overcrowding is present. However, its incidence in developed countries has decreased due to better living condition and high level of sanitation, along with development of potent antibiotics and better medical care. 

The disease affects all the parts of the body including:

a) Heart (cardiac)

b) CNS (central nervous system)

c) Joints

d) Skin

 

 

Common causes and risk factors include:

1. ARF occurs in some 3% to 6% of susceptible population after infection of the upper respiratory tract with Lancefield Group A ß-hemolytic streptococci.

2. Prevalence of rheumatic heart disease (RHD) peaks between 25 years and 40 years and is rare in persons aged >40 years.

3. Recurrent episodes of ARF remain relatively common in adolescents and young adults.

 

 

Some of the common symptoms include:

1. Low grade fever

2. Anorexia

3. Sore throat

4. Irritability

5. Fatigue

 

 

1. The diagnosis is based on revised Jones Criteria, which includes:

Your doctor may recommend you to get following tests done to diagnose the infection. Evidence of streptococcal infection can be found with,

a) Throat swab

b) Antistreptolysin O titre: More than 250 Todd units are significant.

2. Acute phase reactants are typically raised:

a) WBC count: More than 15000/mm

b) ESR

c) C-reactive protein (CRP)

3. Blood cultures, if febrile

4. X-ray chest

5. ECG

6. 2D-echocardiography and Doppler studies

 

 

Preventions include:

1. Primary prevention

a) Early treatment of streptococcal pharyngitis (sore throat) with penicillin or erythromycin before the attack of rheumatic fever develops.

b) High standard of hygiene

c) Effective control of overcrowding should be achieved

2.Secondary Prevention

a) The mainstay of controlling ARF and RHD is secondary prevention as patients with ARF are at dramatically higher risk than the general population of developing a further episode of ARF after a group A streptococcal infection.

b) They should receive long-term prophylaxis with benzathine penicillin G (1.2 million units) given every 3 weeks or oral penicillin V (250 mg) given twice daily. In penicillin-allergic patients erythromycin (250 mg) twice daily can be given to prevent recurrences; for 10 years after the last attack, or 25 years of age (whichever is longer).

 

 

There is no treatment for ARF that has been proven to alter the likelihood of developing, or the reducing the severity of RHD. The treatment of ARF is symptomatic and includes:

1. Medications include, 

a) Antibiotics such as penicillin and erythromycin

b) Analgesics such as aspirin for arthritis. However, toxicity may cause tinnitus, hyperventilation, and metabolic acidosis.

c) Steroids are thought not to have a major impact on outcome, but they may improve symptoms.

2. General measures include bed rest until CRP normal for 2 weeks (may be 3 months).