Acute Rheumatic Fever: Symptoms, Causes, and Treatment

Rheumatic fever

It is not a minor fever; it affects the heart. Rheumatic fever is very dangerous. This is a serious health problem. If it is not treated earlier, it damages the heart permanently and increases the risk of stroke.

Rheumatic fever is a disease when strep throat or scarlet fever isn’t correctly managed. An infection causes strep throat and scarlet fever with streptococcus bacteria.

This severe sickness mostly seems in the ages of 5 to 15 year of children.

Acute rheumatic fever is an acute autoimmune collagen disease that occurs as a hypersensitivity reaction to group-A beta-hemolytic streptococcal infection.

It is the inflammation and lesions of the connective tissue and endothelial tissue.

It affects the heart, joints, blood vessels, and other connective tissue.

Acute rheumatic fever`s predisposing factors are genetic predisposition, temperate climate, winter season, unhygienic living conditions, overcrowding in the family, low dietary intake, and increasing immunological response.

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Table of Contents

Major sign and symptoms

  • Carditis
  • cardiomegaly
  • Tachycardia 
  • New murmurs or change in murmurs
  • Muffled heart sounds
  • Pericardial function rub
  • Chest pain
  • Changes in ECG prolonged PR interval
  • fever

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Polyarthritis

  • It is usually a flitting or migratory type of joint inflammation with pain
  • Decreased active movements
  • Warm
  • Tenderness
  • Redness and swelling
  • Two or more joints are affected Commonly knee, ankles, and elbows are involved in.

Chorea

  • It is purposeless involuntary, rapid movements, usually associated with muscle weakness, incoordination, involuntary facial grimace, speech disturbance, and emotional disturbances
  • Subcutaneous nodules: it is found as a firm, painless nodule over the extensor surface of certain joints, occiput, and vertebral column.
  • Erythema marginatum: it is a pink, macular nonitching rash, found mainly over the trunk, sometimes on the extremities but never on the face
  • It is transient and brought out only by heat and migrates from place to place.

Minor sign and symptoms

  • Fever
  • Arthralgia: Pain in the joint occurs in about 90 % of cases
  • The previous attack of rheumatic fever or rheumatic heart disease is applicable for the second attack of rheumatic fever
  • ECG changes with prolonged PR interval
  • Elevated ESR or presence of C-reactive protein may be considered as minor criteria

Essential criteria

  • Elevated antistreptolysin-O (ASO)
  • Positive throat swab culture may show streptococcal infection

Other sign and symptoms

Precordial pain, abdominal pain, headache, easy fatigability, general weakness, tachycardia, malaise, sweating, vomiting, skin rash, anemia, weight loss, etc.

Diagnostic evaluation

  • Doppler echocardiography is considered an essential diagnostic approach
  • Artificial subcutaneous nodule test
  • Endomyocardial biopsy
  • X-ray
  • ECG
  • Blood test for ESR, WBC

Treatment

  • Bed rest is essential in the direction of children with rheumatic fever
  • Nutritious diet to be provided with a sufficient amount of protein, vitamins, and micronutrients; the salt restriction is unnecessary unless CCF is present; avoid fatty and spicy food.
  • Antibiotic therapy: penicillin
  • Aspirin is used as supportive therapy to control pain and inflammations of joint Steroid.
  • therapy is given as suppressive therapy along with aspirin
  • Management of Chorea can be done with diazepam or phenobarbitone
  • Treatment of complications, if present, especially for CCF, should be done.
  • Symptomatic care to be provided accordingly
  • Good nursing care with emotional support to the child and patents is as critical as the medication.

Prevention of rheumatic fever

  • Primary prevention can be achieved by educating the people to avoid streptococcal sore throat and eliminating predisposing factors of the disease
  • Treatment of streptococcal with penicillin or other medications can be a useful measure to prevent the primary attack of rheumatic fever
  • Secondary prevention of the disease can be done by early detection, adequate treatment, and prevention of recurrences of rheumatic fever
  • Long-acting penicillin therapy should be continued every 15 days OR 21 days for at least five years.
  • Parents should be made aware of the continuation of treatment, medical help, and follow –up.

Complications

  • Involvement of mitral valve as mitral incompetence or mitral stenosis
  • Aortic involvement may be observed as aortic incompetence
  • Heart failure
  • Infective endocarditic.
  • Pericardial effusion.
  • Permanent cardiac damage           
  • In some instances, it damages the heart permanently. Some of the damage caused by the sickness might not show up until one year later. Aware of the long term effect as your child grows older.

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