It often involves the heart and joints, leaves a permanent damage and results in consequences leading to a surgery.
Although other effects are minor and temporary, the effect on cardiac valves is most dangerous and can leave permanent damages for a lifetime.
Rheumatic fever can be caused by bacteria called Beta hemolytic streptococcus that grow on the throat and leads to angina. However, that does not mean that anyone who has this bacteria growing on the throat must catch rheumatic fever. 1-2% of patients suffered from angina catch rheumatic fever. Some constitutional factors that vary from person to person play role in development of this disease. Some persons are only carriers and do not get sick, and can have streptococcus on the throat. Such patients are called “contact” and do not require a treatment if no symptoms of inflammation are present.
Rheumatic fever is not infectious. However, bacteria called streptococcus that causes rheumatic fever and inflammation of throat is infectious.
Although no positive evidence on genetic transition (heredity), it can be more common in some families.
It commonly appears in children between the ages of 5 and 15. It is quite rare other than these ages. Since the possibility of recurrence is higher in children who have previously had rheumatism, they can catch it when they are older than 15 years old. Therefore, a person who has previously suffered from rheumatism needs to be protected by repository penicillin.
Growing streptococcus on the throat does not mean a rheumatic state. Only a certain portion of patients (around 3-5%) whose angina was ill-treated and who are prone to this disease (yaklaşık%3-5) are likely to suffer from rheumatism.
Another issue, which is commonly but wrongly known by public, is ASO value. The higher ASO value indicates only that a streptococcal inflammation has occurred within the last couple of months. It is favorable if any rheumatic signs are present. Higher ASO value alone does not mean anything without other signs. But unfortunately many patients are diagnosed with rheumatism without even considering other signs and valuable laboratory findings just because the ASO value is high, and receive unnecessary treatment.
Leg pain is very common in children particularly who are active or involved in sports. Especially lower-leg pain or pain in knees is non-noxious and subsided by resting and massaging. If a night-pain accompanied by fever is present and not subsided in the morning, if the child has difficulty in moving and if any of the signs, e.g. swelling joint, redness and heat, are present, they should suggest a rheumatic state.
No, rheumatic fever can only involve the joints as well as the heart. Even if it only involves the joints first, the heart can also be affected if it recurs. Therefore, preventing recurrence of the disease can also prevent involvement of the heart, and it is much easier and effortless than trying to treat.
It is dysfunction of valves and heart depending on the damage to heart and valves caused by rheumatism. For example, persons who have a history of rheumatism might have initially insufficiency in other words blood leaking related to poor closure of valves then signs of thickness and narrowing of valves might appear after long years. Moreover, some patients might present symptoms of cardiac rheumatism in middle ages depending on the mild rheumatism in childhood. This is called silent cardiac rheumatism.
Yes, it is highly likely for this disease to recur. The chance of catching it again for a person who has had it for once is highly higher than those who have never caught it. Therefore the patients must receive repository penicillin every 3 weeks for protection against recurrence. Each rheumatic recurrence gradually causes more damage to valves of the heart and even replacement of valves by an operation may be required. This is both expensive and serious operation. Even the best artificial valve never works as perfectly as your own valve. After replacement of the valve, you must always use drugs to protect the valve against microbial growth and to prevent clot formation. Thus, the best thing to do is early diagnosis, good treatment and prevention of recurrence.
Within several weeks following fever and pain in throat, the symptoms such as painful and swelling joints, redness, headache, nausea, vomiting, fatigue, quick tiredness, apnea, and tachycardia might appear. Even if one or several of these symptoms appear, the possibility of recurrence of rheumatism must be investigated.
Those who have cardiac rheumatism should be checked every 6-12 months depending on the severity of valvular problem, those who have only joint rheumatism should be checked every 1-2 years.
Myocardial inflammation and necrosis depending on various causes. Acute and chronic Coxsackie B virus is typical examples of myocarditis (account for 50%).
It can vary between asymptomatic manifestation and chronic myocarditis + dilate cardiomyopathy depending on the age, being acute or chronic, and immune response of person. It can progress very severely and rapidly in newborns whereas the diagnosis can only be made in infants and children when they develop cardiomyopathy .
The symptoms include fever, tachycardia, gallop rhythm, cyanosis, gray skin (sign of shock), respiratory distress, severe cardiac insufficiency, and hepatomegaly. The sound of heart beats come from deep; signs of acidosis are present, and murmur of mitral regurgitation can be auscultated in apex.
The symptoms include fever, tachycardia, chest pain, signs of influenza, gallop rhythm, dysrhythmia, signs of cardiac insufficiency, and signs of mitral and tricuspid insufficiency. The findings of Tele and ECG are same.
Sedimentation is higher, cardiac enzymes (SGOT, CK MB band, LDH) and Coxsackie virus IgM are also higher. Especially Coxsackie virus IgM can remain high for 5-10 years. Cardiac dilatation, valvular insufficiency, and failure of myocardium to contract which appear on echocardiography support the diagnosis. The final diagnosis is made by biopsy.
Bed rest, oxygen, monitorization (in case of sudden deaths), drugs to strengthen myocardium, diuretics, restriction of liquids/salt are required. Drugs to regulate the rhythm are administrated in case of arrhythmia. Corticosteroid and immunosuppressive therapy should be considered.
The mortality rate is 75% for newborns. 10-20% can recover spontaneously. The rate of recovery in adults is reported 10-50%. In case of development of dilate cardiomyopathy, untreated 50% die within the first 2 years.
A disease causing vasculitis od medium-sized arteries including coronary arteries accompanied by skin eruption and fever in children particularly younger than 5 years old. It is not infectious but expected to play a superantigen role in development of certain types of bacteria toxins. Autoimmunity is also considered but no definite data is available. It is good if prognosis coronary aneurism has not been developed; the disease is subsided spontaneously.