RHEUMATIC FEVER

General Information

DEFINITION--An inflammatory complication of Group A streptococcal infections that affects many parts of the body, especially the joints and heart. Strep infections are contagious, but rheumatic fever is not.

BODY PARTS INVOLVED--Joints; heart and heart valves; skin and brain (sometimes).

SEX OR AGE MOST AFFECTED--Both children and adults.

SIGNS & SYMPTOMS

Joint inflammation, characterized by pain, red-ness, swelling and warmth that can move from one joint to another. Wrists, elbows, knees or ankles are most often affected. Joint inflamma-tion usually subsides in 10 to 14 days, but with-out treatment, other joints may become inflamed. Fever; fatigue; paleness. Appetite loss; general ill feeling. Abdominal pain; chest pain. Mild skin rash on chest, back, abdomen. Small, painless bumps just under the skin in bony areas such as the elbows or knees. If the heart is involved:

• Shortness of breath.
• Fluid retention that causes swelling of the legs and back.
• Rapid heartbeat, especially when lying down.
• Uncontrollable arm and leg movement (chorea).

CAUSES--Rheumatic fever is caused by a preceding strep infection, usually in the throat, that occurs 1 to 6 weeks prior to the onset of symptoms. It is probably an autoimmune disorder in which antibodies produced to attack the strep bacteria also attack tissues of the joints or heart.

RISK INCREASES WITH

• Poor nutrition.
• Family history of rheumatic fever.
• Crowded or unsanitary living conditions.
• Tendency to upper respiratory infections.
• Untreated strep infections or incomplete treatment.

HOW TO PREVENT

• Request a throat culture for strep for any throat infection, especially in a child.
• Obtain prompt antibiotic treatment of any strep infection, including those of the skin. Strep infections must be treated with antibiotics, usually penicillin, for 10 days orally or by long-lasting injection.

What To Expect

DIAGNOSTIC MEASURES--

• Medical history and exam by a doctor.
• Laboratory studies, such as blood studies, a throat culture and ECG (See Glossary).
• X-rays of the chest and heart.

APPROPRIATE HEALTH CARE

• Doctor's treatment.
• Home care after diagnosis (mild cases).
• Hospitalization (severe cases).

POSSIBLE COMPLICATIONS

• Permanently damaged heart valves, leading to congestive heart failure.
• Subsequent attacks of acute rheumatic fever.

PROBABLE OUTCOME--Strep infections are usually curable with treatment. Rheumatic fever is treatable, but not curable. It will subside in 2-12 weeks. In some cases, rheumatic fever may damage the heart valves. A damaged valve can be replaced with surgery. In rare cases, rheumatic fever is fatal even with treatment.

How To Treat

GENERAL MEASURES--

• Take the patient's temperature and count the pulse; keep a record for your doctor.
• Use a cool-mist, ultrasonic humidifier if the patient has a sore throat or cough.
• Good dental hygiene is important.
• See Resources for Additional Information.

MEDICATION--Your doctor may prescribe:

• Steroids (anti-inflammatory drugs) or aspirin to reduce inflammation.
• Diuretics to reduce fluid retention.
• Antibiotics to fight any remaining strep bacteria.

ACTIVITY--The patient should stay in bed until studies show the disease has subsided. Bed rest for 2 to 5 weeks is usually required, but some cases require months. Provide a bed pan or bedside commode.

DIET--

• A liquid or soft diet (see both in Appendix) in the early stages, progressing to a normal diet high in protein, calories and vitamins.
• A low-salt diet may be recommended.

Call Your Doctor If

• The following symptoms occur during treatment: Swelling of the legs or back. Shortness of breath. Vomiting, diarrhea or cough. Severe abdominal pain or fever.
• New, unexplained symptoms develop. Drugs in treatment may produce side effects.