Rheumatic fever and rheumatic heart disease were major causes of death and disability throughout the world 50 years ago. But today rheumatic fever is so rare because of the advancement in medical science. All the modern equipment and treatment made rheumatic fever preventable. If you are still unaware of this fever, continue reading and grab knowledge.
What is Rheumatic Fever?
Rheumatic fever is a disease of the joints and heart. It occurs as a result of an immune reaction following infection with specific types of streptococcal bacteria. It is acute but may become chronic and progressive.
It is also characterized by an inflammatory process involving collagen fibrils, which often results in lasting damage to heart valves besides involving the pericardium. This irreversible valvular damage is known as “Rheumatic Heart Disease.”
Rheumatic fever has five major and five minor manifestations. The major manifestations include carditis, chorea, erythema marginatum, polyarthritis and subcutaneous nodules. Let’s discuss in detail:
Carditis: Carditis or inflammation of the heart, occurs in 40-50% of initial cases of rheumatic fever. It is the only major manifestation capable of causing death or permanent damage.
Chorea: Also known as Sydenham’s chorea or St. Vitus’ dance, is an uncontrollable spasmotic movement of the voluntary muscles of the extremities and face. The irregular movements are non-repetitive and purposeless, and occur only during waking hours.
Erythema Marginatum: It is a red, non-pruritic rash of the trunk and extremities. It occurs frequently on the trunk or thighs and most commonly in conjunction with arthritis, carditis, chorea and lassitude. It rarely lasts more than 4 days.
Polyarthritis: It is characterized by inflammation of the large joints, particularly the ankles and knees and occasionally the small joints of the wrists and elbows. Severe pain is the primary symptom with later complaints of redness, tenderness and swelling. The arthritis dissipates in about 2 to 3 weeks without residual damage.
Subcutaneous Nodules: It is painless, firms, pea-sized swellings that form over extensor surfaces or bony prominences, usually around the elbows, hands and feet. They resolve spontaneously in about 2 weeks.
The minor manifestations and associated factors are fever (100 degree to 102 degree F), arthralgia, previous rheumatic fever or rheumatic heart disease, abnormal sedimentation rate or positive C – reactive protein and a prolonged PR interval in the ECG recording. Nonspecific minor manifestations that may be present, but are not part of the criteria for diagnosis, include lassitude and abdominal pain.
The diagnosis of rheumatic fever is made based on the presence of two major manifestations or one minor and two minor manifestations. Polyarthritis and carditis are the most frequent clinical manifestations, occurring in combination in 44% of patients.
The medical treatment of rheumatic fever consists of prompt antibiotic therapy with large doses of intramuscular penicillin G benzathine. Bed rest and anti-inflammatory compounds such as aspirin and corticosteroids are generally prescribed rheumatic heart disease.