From tomorrow, the world will dedicate the next 7 days to sensitising the world about Rheumatic fever. Rheumatic fever is a chronic inflammatory disease that affects the joints, skin, heart, blood vessels and brain. It is a systemic immune disease which can develop after an infection with bacteria known as streptococcus, i.e strep throat and scarlet fever. 

Rheumatic fever can also lead to rheumatic heart disease which occurs after repeated bouts of acute illness.

According to medics, it’s the most common cause of pediatric heart diseases worldwide. If rheumatic fever is prolonged without treatment, it can also damage the valves of the heart and result into heart (cardiac) failure.

According to research published by World Heart Federation (WHF), 2009, rheumatic fever is very common in poorer parts of the world such as Africa, the Middle East and South America, where there is overcrowding, poor sanitation and limited access to medical treatment. Research also estimates that just fewer than half a million new cases of rheumatic fever occur worldwide yearly. It’s also the most common acquired heart disease found among children and young people mainly between the age of 5 and 15 years.

Causes

Dr Rachna Pandey, a specialist in internal medicine at Ruhengeri Hospital, says poverty and overcrowding are conditions which predispose rheumatic fever. She says the infection is presumed to cause antigen antibody reaction in the body.

"Symptoms can start as early as from one week to four weeks which triggers various manifestations after the patient has been infected with bacteria (streptococcus). Although the symptoms are common and alike, each patient may experience symptoms differently, there is fever along with migratory joints pain and breathlessness due to inflammatation of the heart,” she says.

She adds that if rheumatic fever goes on without treatment, it can cause damage to valves of the heart. These damaged valves, according to her, can lead to heart failure because of impaired functioning of the heart.

More studies have also established that streptococcus group A beta hemolytic infection may lead to rheumatic fever. The overall attack rate after streptococcal tonsillitis is between 0 and 5 percent but individuals who acquired the disease genetically comprise between 3 percent and 6 percent.

Symptoms

According to Mayo Clinic, a medical practice and medical research group based in the US, Rheumatic fever symptoms may vary. Some people may have several symptoms, while others experience only a few. The symptoms may also change during the course of the disease. The onset of rheumatic fever usually occurs about two to four weeks after a strep throat infection.

Rheumatic fever signs and symptoms — which result from inflammation in the heart, joints, skin or central nervous system — may include fever and painful and tender joints — most often the ankles, knees, elbows or wrists; less often the shoulders, hips, hands and feet. Others are pain in one joint that migrates to another joint; red, hot or swollen joints; small, painless nodules beneath the skin; chest pain; heart murmur and fatigueYou should also get concerned when you experience a flat or slightly raised, painless rash with a ragged edge (erythema marginatum), jerky, uncontrollable body movements — most often in the hands, feet and face and outbursts of unusual behaviour, such as crying or inappropriate laughing.

Treatment

The goals of treatment for rheumatic fever are to destroy any remaining group A streptococcal bacteria, relieve symptoms, control inflammation and prevent recurring episodes of rheumatic fever.

According to Dr Paul Mizero of Le Plateau Clinic in Kigali, the treatment of rheumatic fever depends on how serious the disease is.

"Group A streptococcal infection that leads to disease may be administered to the patience, it can help in reducing of the spread of rheumatogenic strains, anti-inflammatory agents are used to control the arthritis, fever and other rheumatic fever symptoms.” says Mizero.

Mizero also adds that bed rest can also be used as a medication for those patients with carditis.

"Bed rest is a traditional part of rheumatic fever therapy where patients are typically advised to rest through the rheumatic fever illness and then gradually increase activity.” he says.

Dr Pandey says that diagnosis is made on basis of clinical features, estimating titer (substance concentration) of anti streptococcal antibodies in blood, blood culture if possible. She says that if a child has inflamed tonsillitis with pain and fever, skin rashes or patchier with fever, enlarged lymph nodes in neck, that child should be given antibiotics.

She explains that although penicillin is usually used for prevention of rheumatic fever, it can also be given in confirmed cases for preventing relapse. If inflammation persists, anti inflammatory drugs can be used with antibiotics to reduce it. In case of the damaged valves of the heart and cardiac failure, one needs medicines to treat it.

Who is most affected?

Dr Mizero says although the cases of the rheumatic fever are not common, they still exist. He says most of the people he has treated are children (between the age of 5 and 15) and women.

"It is relatively rare in infants and uncommon in preschool aged children. Rheumatic fever can occur in young adults but the incidence falls steadily after adolescence. It then becomes rare after the age of 35 years. In adults the lower rate of rheumatic fever may mean a decreased risk of streptococcal tonsillitis, recurrent episodes which causes damaging of the valves continue until middle age.” he says.

He says although rheumatic fever has no clear-cut sexual prediction, certain clinical manifestations are more common in females who have gone through puberty.