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Rheumatic fever

Rheumatic fever is an inflammatory disease which may develop after a Group A streptococcal infection (such as strep throat or scarlet fever) and can involve the heart, joints, skin, and brain. more...

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General Information

Rheumatic fever is common worldwide and is responsible for many cases of damaged heart valves. In the Western countries, it became fairly rare since the 1950's, possibly due to higher hygienic standards. While it is far less common in the United States since the beginning of the 20th century, there have been a few outbreaks since the 1980s. Although the disease seldom occurs, it is serious and has a mortality of 2 - 5%.

Rheumatic fever primarily affects children between ages six and 15 and occurs approximately 20 days after strep throat or scarlet fever. In up to a third of cases, the underlying strep infection may not have caused any symptoms.

The rate of development of rheumatic fever in individuals with untreated strep infection is estimated to be 3 percent. The rate of development is far lower in individuals who have received antibiotic treatment. Persons who have suffered a case of rheumatic fever have a tendency to develop flare-ups with repeated strep infections.

The recurrence of rheumatic fever is relatively common in the absence of maintenance of low dose antibiotics, especially during the first three to five years after the first episode of rheumatic fever. Heart complications may be long-term and severe, particularly if the heart valves are involved.

Diagnosis: Modified Jones Criteria

T. Duckett Jones, MD first published these criteria in 1944. They have been periodically revised by the American Heart Association in collaboration with other groups. Two major criteria, or one major and two minor criteria, when there is also evidence of a previous strep infection support the diagnosis of rheumatic fever.

Major Criteria

  • Carditis: inflammation of the heart muscle which can manifest as congestive heart failure with shortness of breath, pericarditis with a rub, or a new heart murmur.
  • Migratory polyarthritis: a temporary migrating inflammation of the large joints, usually starting in the legs and migrating upwards.
  • Sydenham's chorea (St. Vitus' dance): a characteristic series of rapid movements without purpose of the face and arms. This can occur very late in the disease.
  • Erythema marginatum: a long lasting rash that begins on the trunk or arms as macules and spread outward to form a snakelike ring while clearing in the middle. This rash never starts on the face and is made worse with heat.
  • Subcutaneous nodules (a form of Aschoff bodies): painless, firm collections of collagen fibers on the back of the wrist, the outside elbow, and the front of the knees. These now occur infrequently.

Read more at Wikipedia.org


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Rheumatic fever on the rise
From Pediatrics for Parents, 6/1/88 by Richard J. Sagall

Rheumatic Fever on the Rise Rheumatic fever is a disease that had almost disappeared in this county. The reason for the decline wasn't known for sure, but many medical epidemiologists felt less crowding, better access to medical care, and increased antibiotic availability were important factors. But, for reasons yet to be found, there has been a recent rise in the number of cases of rheumatic fever.

Rheumatic fever is commonly, though not exclusively, acquired when a strep throat is not treated. In epidemics, about 3 percent of people with untreated strep throat develop rheumatic fever. Rheumatic fever causes inflammation of the heart 90 percent of the time, which often, but not always, leads to valve damage.

Rheumatic fever itself is not contagious. Strep throat is spread by close contact. It's one of the most common infectious diseases in 5 to 15 years olds.

It's been though that treatment of strep throat prevents rheumatic fever, but recent outbreaks contradict this idea. In a recent Salt Lake City outbreak, most of the people who developed rheumatic fever had very mild -- or no -- symptoms of strep throat and didn't seek medical care until the rheumatic fever developed.

Recent outbreaks in Pittsburgh, Columbus, Akron and other cities have followed a similar pattern, affecting mostly middle-class families. Parents and physicians need to pay attention to minor childhood sore throats, particularly in areas where there have been cases of rheumatic fever.

COPYRIGHT 1988 Pediatrics for Parents, Inc.
COPYRIGHT 2004 Gale Group

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