Rheumatic (roo-MAH-tik) fever is a complication of a group A streptococcal infection, such as strep throat or scarlet fever, that can lead to permanent heart damage and death. It is most common in children.
By the early 1980s, only about 1 in every 100,000 Americans developed rheumatic fever. But by 1985, the disorder had reemerged as a significant problem in some communities. There were outbreaks in Salt Lake City, New York, Dallas, San Diego, Akron, and Columbus.
Doctors were puzzled and renewed their interest in fighting rheumatic fever. The number of cases remained small in the United States, while in poor, less-developed countries rheumatic fever was a significant problem. Doctors were uncertain if the fever's comeback in the United States was temporary, but it showed that everyone needs to be watchful for the effects of strep infections.
Rheumatic fever sometimes results when the body's immune system reacts to infection by a bacterium known as group A streptococcus, commonly called strep. The same bacteria that cause strep throat can lead to other disorders, such as scarlet fever.
When the body becomes infected with the strep bacteria, the immune system * produces antibodies to fight the infection. Rheumatic fever results when these antibodies begin to attack other parts of the body instead of just fighting the infection. The antibodies react to organs such as the heart as if they were the strep bacteria, perhaps because parts of these organs are chemically similar to strep.
Doctors are not sure exactly why some strep infections develop into rheumatic fever and others do not. The disorder occurs most often in children between 5 and 15 years of age, although it can strike younger children and adults, too.
The first signs of rheumatic fever usually occur within several weeks after a strep throat infection. Sometimes people appear to have recovered from the sore throat but suddenly begin to show other symptoms, such as:
The most dangerous consequence of rheumatic fever is inflammation and weakening of the heart muscle. The valves that control passage of blood in and out of the heart can be damaged so that they fail to open and close properly. This condition is called rheumatic heart disease. During an acute episode of rheumatic fever, a physical examination might produce abnormal findings regarding the heart; however, these can be subtle. The heart damage that leads to poor function of the cardiac valves may take months to years to develop (after the initial episode) with symptoms and clinical findings on cardiac examination.
A doctor may suspect a strep infection if a patient with a sore throat also has a fever and severe headache. However, the symptoms and physical exam findings in people with strep throat are very similar to those in people with sore throat due to a virus infection or other cause. Therefore, strep infections must be confirmed with laboratory tests. Doctors use a cotton swab to wipe the throat to test for the strep bacteria.
If the infection is caused by strep, the doctor usually prescribes an antibiotic to be taken by mouth for several days or given as a one-time shot. Doctors stress that it is important to take all the antibiotic prescribed, even if the symptoms of the strep infection disappear.
Not all untreated strep infections lead to complications such as rheumatic fever. For people who get rheumatic fever, doctors use antibiotics as well as other drugs that reduce swelling and relieve pain. They also closely watch the heart to ensure that there are no problems with blood flowing through it. If the heart valves are damaged, surgery might be necessary to fix one or more valves.
The best way to avoid rheumatic fever is to treat strep infection promptly with antibiotics. Doctors, however, are concerned that some bacteria may become resistant to traditional antibiotics. Researchers continue to explore the best ways to use antibiotics and the development of new drugs to fight infections.
See also Heart Disease: Overview • Scarlet Fever • Sore Throat/Strep Throat • Streptococcal Infections
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* immune system (im-YOON SIStem) is the system of the body composed of specialized cells and the substances they produce that help protect the body against disease-causing germs.