rheumatic fever - General information, Pathophysiology, Treatment, Prevention

A common disease of children and adolescents in Asia and Africa, arising from an immunological reaction to preceding infection with certain strains of Streptococcus (eg scarlet fever). It is characterized by fever, a flitting arthritis (in which pain and swelling moves from joint to joint), and inflammation of the heart (carditis). While joint involvement rarely leads to persisting deformity, serious rheumatic heart disease can produce permanent distortion, narrowing, and incompetence of the valves of the heart.

Rheumatic fever
Classifications and external resources

ICD-10	I00-I02
ICD-9	390–392
DiseasesDB	11487
MedlinePlus	003940
eMedicine	med/3435  med/2922 emerg/509 ped/2006

Rheumatic fever is an inflammatory disease which may develop after a Group A streptococcal infection (such as strep throat or scarlet fever) and can involve the heart, joints, skin, and brain.

General information

Rheumatic fever is common worldwide and is responsible for many cases of damaged heart valves.

Rheumatic fever primarily affects children between ages six and 15 and occurs approximately 20 days after strep throat or scarlet fever.

The rate of development of rheumatic fever in individuals with untreated strep infection is estimated to be 3%.

The recurrence of rheumatic fever is relatively common in the absence of maintenance of low dose antibiotics, especially during the first three to five years after the first episode of rheumatic fever. Heart complications may be long-term and severe, particularly if the heart valves are involved.

Major criteria

Carditis: inflammation of the heart muscle which can manifest as congestive heart failure with shortness of breath, pericarditis with a rub, or a new heart murmur.

Minor criteria

Fever: temperature elevation Arthralgia: Joint pain without swelling Laboratory abnormalities: increased Erythrocyte sedimentation rate, increased C reactive protein, leukocytosis Electrocardiogram abnormalities: a prolonged PR interval Evidence of Group A Strep infection: positive culture for Group A Strep, elevated or rising Antistreptolysin O titre Previous rheumatic fever or inactive heart disease

Other signs and symptoms

Abdominal pain Epistaxis

Pathophysiology

Rheumatic fever is an autoimmune disease which occurs after an untreated Group A streptococcal infection, typically a throat infection.

Treatment

The management of acute rheumatic fever is geared toward the reduction of inflammation with anti-inflammatory medications such as aspirin or corticosteroids.

Infection

Patients with positive cultures for streptococcus pyogenes should be treated with penicillin as long as allergy is not present.

Inflammation

Patients with significant symptoms may require corticosteroids.

Heart failure

Some patients develop significant carditis which manifests as congestive heart failure. Unlike normal heart failure, rheumatic heart failure responds well to corticosteroids.

Prevention

Prevention of recurrence is achieved by eradicating the acute infection and prophylaxis with antibiotics.

Nurses also have a role in prevention, primarily in screening school-aged children for sore throats that may be caused by group A streptococci.