Inflammation of the heart, joints, and skin following bacterial infection
- Most common in people aged 5–15, but effects often not seen until adulthood
- Overcrowded living conditions and inadequate nutrition are risk factors
- Gender and genetics are not significant factors
Fifty years ago, rheumatic fever was a major childhood illness in Europe and North America that left thousands of people with damaged heart valves. The effects of the damage are now being seen in elderly people as heart valve disorders, most commonly as mitral stenosis. Rheumatic fever is now rare in developed countries, mainly due to the use of antibiotics and to improved standards of living. In the UK, it is estimated that the incidence of rheumatic fever is less than 1 case per 100,000 people per year. However, the disease still affects many people in developing countries.
Rheumatic fever develops after an infection, usually of the throat, caused by streptococcal bacteria. The condition is caused by the immune system attacking the body’s tissues in response to the infection.
What are the symptoms?
Rheumatic fever develops 1–4 weeks after the sore throat has cleared up. Symptoms may include:
Aching and swelling of larger joints, such as the knees, elbows, and ankles.
Characteristic blotchy pink rash on the trunk and limbs.
If the heart muscle is affected, there may be shortness of breath and chest pain for a few weeks until the inflammation settles. Inflammation of a heart valve causes permanent damage that may lead to thickening and scarring of the valve years later. Valve damage causes symptoms such as excessive tiredness.
What might be done?
If rheumatic fever is suspected, a swab is taken from the throat and a blood test carried out to look for streptococcal infection. A chest X-ray may be taken to look at the size of the heart to see if it is inflamed. An ECG may be performed to monitor electrical activity in the heart and echocardiography to image the interior of the heart and the valves.
Rheumatic fever is treated with antibiotics to clear up the infection and complete bed rest for about 2 weeks. Nonsteroidal anti-inflammatory drugs may be used to reduce fever and joint inflammation, and corticosteroids may be prescribed to reduce inflammation of the heart. Low-dose antibiotics often need to be taken for up to 5 years to avoid recurrence.
About 1 in 100 people dies during an initial attack of rheumatic fever. The risk of a recurrence is highest in the first 3 years after the initial infection in young adults and people with damaged heart valves. After 10 years, 2 in 3 people have a detectable heart valve disorder.
From the 2010 revision of the Complete Home Medical Guide © Dorling Kindersley Limited.
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