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Rheumatic fever

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Rheumatic fever is a type of disease characterized by inflammation that affects the heart, joints, skin, spinal cord and brain. It is caused by Group A Streptococcal bacteria and typically afflicts children between the ages of 6 to 15.

RHEUMATIC FEVER SIGNS AND SYMPTOMS

Rheumatic fever is widespread around the globe and is considered a serious ailment, particularly in developing countries, with a mortality rate of 2 to 5%. However, the use of antibiotics have made it almost rare in the United States, with fewer eruptions of the disease in the 20th century.

Rheumatic fever is a complication of scarlet fever or strep throat, infections which are also caused by the Streptococcus bacteria. The fever usually sets in around 20 days after the onset of these ailments and can cause extensive damage to a person's heart valves (rheumatic carditis), particularly in 3% of strep infections that are left untreated. In these cases, there is a 50% chance of its recurrence if the disease is not treated with the proper antibiotic medications.

The damage to an infected person's heart valves can cause long-term and serious complications. Rheumatic fever can prevent blood from flowing normally through the heart and lead to permanent scarring of the heart valves. This damage can result in an ailment also known as rheumatic heart disease, which usually escapes diagnosis until much later in a person's life.

People with Rheumatic fever will exhibit high temperatures, and joint pain without swelling (Arthralgia) particularly affecting the elbows, wrists, knees and ankles. The joints will also tend to swell (Migratory polyarthritis), exhibiting redness and warmth in the affected area. There will also be the presence of abdominal pain and an outbreak of a red or pale pink skin rash known as Erythema marginatum. These long lasting skin eruptions are characterized by their ring or snake-like shape and usually appear on the trunk or upper extremities. The afflicted person will likewise develop skin nodules. These painless knots of collagen fibers grow on the wrists, elbows and knees.

Sufferers of Rheumatic fever are also prone to a disorder known as Sydenham's chorea which affects the brain and occurs in the advanced stages of the disease. This syndrome causes unstable emotions, and weak muscles which result in the patient's face, hands and feet moving in uncoordinated and jerky motions. Nosebleeds (Epistaxis) are also a common symptom of Rheumatic fever, as are chest pain and shortness of breath which are signs of inflammation of the heart muscle. Because of this, afflicted persons almost always feel tired and may end up with congestive heart failure or even develop a heart murmur.

RHEUMATIC FEVER DIAGNOSIS

Medical research has yet to pinpoint the exact cause of Rheumatic fever. One theory is based on abnormalities in the immune system that react to Streptococcal bacteria by breaking out into Rheumatic fever. Researchers are also studying the the genes of patients suffering from this disease to determine whether there exists a genetic predisposition that causes a response to Streptococcal infections in a like manner.
Rheumatic fever
Image: Rheumatic fever


Apart from damage to the heart valves, also known as Mitral stenosis or Aortic stenosis, Rhematic fever can result in complications like Endocarditis, an inflammation of both the heart valves (endocardium) and the inner lining of the heart chambers. Irregular heart rhythms, or Arrhythmias may also develop, as well as Pericarditis, a condition characterized by the inflammation of the heart's sac-like lining known as the pericardium.

In more severe cases of the disease, the inflammation brought about by Rheumatic fever causes so much damage to the heart that it results in heart failure. Surgery will be needed to correct the damage to the heart valves when this happens.

People who have a family history of Rheumatic fever have a higher risk for contracting the disease. Living in overcrowded communities where poverty and poor nutrition is rampant is also a risk factor. So are undergoing surgical procedures such as dental operations can increase the chances for infection by Streptococcal bacteria.

RHEUMATIC FEVER RISK FACTOR

As Rheumatic fever is exhibited in different forms, no exact diagnostic test has been developed to test for its presence. A careful exam by a qualified medical practitioner will involve checking the patient's skin for fever, a rash or nodules, arthritis or swelling in the joints, and listening to the heart sounds for any atypical murmurs. An electrocardiogram may also be required to do a thorough testing of the patient's heart to test for irregular rhythms. The doctor may likewise order blood tests to check for the presence of a strep infection.

RHEUMATIC FEVER TEST

Just as there is no particular laboratory test to diagnose Rheumatic fever, there is no cure for it as well. However, the disease can be prevented by immediate treatment of a strep throat infection through antibiotic therapy, such as penicillin injections, erythromycin, or sulfadiazine.

RHEUMATIC FEVER TREATMENT

The primary goal of managing Rheumatic fever is to bring down inflammation with the use of anti-inflammatory drugs like corticosteroids or aspirin, as well as ridding the body of any trace of Streptococcus bacteria to avoid future infections.

For patients in an advanced stage of Rheumatic fever who exhibit the signs of congestive heart failure, such as carditis, treatment will involve taking a combination of diuretics and digoxin or prednisone, corticosteroids which are effective for this disease. The doctor may also prescribed steroids to reduce scarring of the heart valves and other accompanying complications.

The doctor may also prescribe salicylate medications to relieve any symptoms of pain, and nonsteroidal anti-inflammatory drugs (NSAIDs) to treat both heart and joint inflammation.


For patients who have had previous bouts of Rheumatic fever, the American Heart Association is recommending regular prophylaxis on a long-term basis to totally destroy any traces of streptococcal infection.

RHEUMATIC FEVER PREVENTION

Prevention is also achieved through the school system, where children with symptoms of sore throats may be screened for Group A Streptococcal bacteria. As a whole, prompt treatment of strep throat infections through a full course of antibiotic therapy will prevent any occurrence of Rheumatic fever. Without antibiotic treatment, the disease is likely to recur within 3 to 5 years after the initial infection.

In Ayurvedic medicine, practitioners have been recently touting Yoga to cure Rheumatic fever. It is believed that the accumulation of toxins known as ama and vata dosha can be eradicated by appropriate herbal medications combined with a special diet, lifestyle and daily yoga exercises specifically designed to get rid of Rheumatic fever symptoms. This alternative method of healing has been said to greatly reduce the body's need for chemical medications.
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