Rheumatic fever overview
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Lance Christiansen, D.O.; Associate Editor(s)-in-Chief: Cafer Zorkun, M.D., Ph.D. [2]
Overview
Rheumatic fever is a systemic immune disease that may develop after an infection with streptococcus bacteria, such as strep throat and scarlet fever. The disease can affect the heart, joints, blood vessels, and brain. Usual symptoms include fever, joint apin, joint swelling, skin nodules, skin rash, epistaxis, even cardiac problems such as shortness of breath, chest pain, and emotion changes. Medical history and physical examination are very important for diagnosis. Antistreptolysin O (ASO) titer can assist in making a diagnosis of rheumatic fever. Treatments include antibiotics to control streptococcus infection and medications such as aspirin and corticosteroids to decrease inflammatory. A long-lasting injection of penicillin is important and effective to prevent further complications and recurrence.
Epidemiology and Demographics
Rheumatic fever, and therefore Streptococus pyogenes infections, are endemic in many developing countries. In countries affected by the industrial revolution, domestic living conditons became less crowded, due to the development of larger homes and families had fewer children. In addition, living conditions became, generally, more hygienic. The introduction of antibiotics, first sulfonamide in the early 1930's and then penicillin in the 1940's, further caused Streptococcus pyogenes infections to become less common and less severe in economically developed countries although they never disappeared. Rheumatic fever is usually seen among children belonging to age group of 5-15 years[1]
Diagnosis
Electrocardiogram
Some of the electrocardiographic changes that may be noted in rheumatic heart disease include PR prolongation, conduction abnormalities, arryhthmias or P mitrale depending on the structures involved and the extent of cardiac damage.
Chest X Ray
Cardiomegaly or pulmonary edema secondary to heart failure may be noted on chest x-ray among patients with rheumatic heart disease.
Treatment
Primary Prevention
Treatment of streptococcal pharyngitis with appropriate antibiotics (penicillin or cephalosporin) most often prevents development of rheumatic fever.
Secondary Prevention
In order to prevent recurrent development of rheumatic fever, an antibiotic prophylaxis should be initiated immediately after the antibiotic course in treatment of rheumatic fever. Duration of prophylactic treatment varies with degree of cardiac damage secondary to rheumatic fever.