Beware of rheumatic fever

Rheumatic fever is caused by the bacteria called Beta-haemolytic streptococcus viridans. The bacteria usually cause a sore throat and rheumatic fever can occur about four weeks following it. It is said to be due to reaction of body producing antibodies against circulating antigens of the causative streptococci. Rheumatic fever usually affects children from 4 to 14 years. It is usually more common in poor children living in slums. Reason being overcrowding causes streptococcal throat infections more frequently and hence rheumatic fever. Typically the fever is mild to moderate with joint pain. Joint involvement in rheumatic fever is characteristic and known as flitting arthritis. Pain and swelling starts from one joint, subsides in one or two days, to appear in another joint. Mostly it is the large joints which are involved. Knees may be inflamed to be followed by ankles, elbows and wrists. The heart may be involved causing inflammation of the layers covering the heart or the heart valves. This can cause heart failure, manifesting as heart failure and breathlessness on exertion and even on rest in severe cases. Neurological involvement can occur later in the disease causing abnormal movements of head and hands a condition known as “sydenham’s chorea”. All these symptoms are distressful as well as frightening to the patient and their families. Diagnosis is based on detection of antibodies against the causative streptococci in the serum of the affected person. The clinical features are so typical that even if no facility for tests is available diagnosis can be made based on them. Treatment consists of aspirin to reduce the pain and inflammation and suitable antibiotics. Bed rest is necessary to reduce the inflammation of joints. Keeping a child in good spirits when he is sick and not allowed to move is yet another problem the family needs to reckon with. A person having rheumatic fever once, is at risk of developing it again if exposed to streptococcal infection. High risk groups may be those in medical profession or students/teachers who may come frequently in contact with students having streptococcal sore throats. If initial infection is mild it may go unnoticed as a brief febrile illness. But the damage inflicted upon the heart may manifest later in the form of valvular abnormalities, that is, abnormalities of the heart valves. This is a grave sequel. It is aptly said that, ‘rheumatic fever licks the joints but bites the heart”. One can have breathlessness and giddiness on exertion due to abnormalities of heart valves. Long term prophylaxis by antibiotics is useful to prevent second attacks and also damage to the heart valves. Antibiotic prophylaxis also helps to prevent secondary infection of the valves of the heart which is a grave condition known as “Infective endocarditis”. One should never take a “sore throat” lightly. Timely treatment can avoid the risk of a more serious condition, that is, rheumatic fever. Keeping good health by means of a healthy life style is very necessary to help build the body’s resistance to combat diseases. Thus a healthy person may be exposed to streptococci or any bacteria for that matter but would not develop any disease. Dr. Rachna Pande is a specialist in internal medicine at Ruhengeri Hospital

Health

Beware of rheumatic fever