Rheumatic (roo-MA-tik) fever is a complication of a strep throat infection that can lead to permanent heart damage and death. It is most common in children.
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* strep throat is a contagious sore throat caused by a strain of bacteria known as Streptococcus.
Until recently, doctors thought rheumatic fever had almost disappeared from the United States. In 1950, before the widespread use of antibiotics to fight strep * infections, more than 22,000 people died of rheumatic fever and the heart disease it caused. During the 1950s, almost 25 of every 100,000 Americans got rheumatic fever each year. But as use of antibiotics such as penicillin became more common in the 1960s, and as more poor children had access to better medical care, rheumatic fever became rare.
By the early 1980s, only about 1 in every 100,000 Americans developed it. But by 1985, the disorder had re-emerged 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 have renewed their interest in fighting rheumatic fever. The number of cases remains small in the United States, although in poor, less developed countries, rheumatic fever is a significant problem. Doctors are not sure if the fever's comeback in the United States is temporary, but it has shown that everyone needs to be watchful for the effects of strep infections.
From a Sore Throat to a Damaged Heart
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 affect 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.
The Discovery of Aspirin
In the mid-nineteenth century, the Reverend Edmund Stone unwittingly discovered the earliest known effective treatment for rheumatic fever and other conditions characterized by rheumatism. Stone, like many physicians of his time, believed that God grew healing herbs for specific diseases in the localities where they naturally ocurred. Willing to put his idea to the test, he administered willow bark, which he himself sampled, to some 50 persons suffering with rheumatic fever. He reported effective results in each case. The bark was later found to contain an active ingredient of salicin (SAL-i-sin), first extracted and analyzed by Dr. Thomas MacLagan in 1839. Other chemists later produced the salicylate (sal-i-SY-late) group of drugs, which yielded sodium salicylate in 1899. This drug came to be known as aspirin and became useful for remedying symptoms associated with rheumatic fever as well as a general pain reliever.
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 ages 5 and 15, although it can strike younger children and adults, too.
Sydenham's chorea is the name for the involuntary movements and twitching that some rheumatic fever patients display.
"Chorea" (pronounced like the country Korea) comes from the Greek word for "dance." During the Middle Ages, chorea was the term used to describe people who traveled to the shrine of St. Vitus in what is now Germany. Some of the people apparently suffered from conditions involving abnormal body movements, such as epilepsy, and hoped to be healed at the shrine. (Catholics consider St. Vitus the patron saint of those with epilepsy, as well as of dancers and actors.)
Dr. Thomas Sydenham, a prominent physician in England during the 1600s, used the term "chorea" in connection with infectious diseases such as scarlet fever. Later, when rheumatic fever also was connected with strep infection, Sydenham's chorea was the term used to describe the shaking of the upper limbs and face caused by swelling of the brain.
Sydenham's chorea is sometimes called St. Vitus' dance.
A Turn for the Worse
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:
- Muscle aches and joint pain and swelling resembling arthritis. The pain usually moves from one joint to another.
- Fever, vomiting, and sometimes nosebleeds.
- A red rash, especially on the chest, arms, and legs, which might disappear in a few hours. Lumps below the skin also may occur.
- Fatigue and problems breathing, because the heart is affected. The heartbeat also may be abnormal.
- Sydenham's chorea (see sidebar), which is uncontrollable twitching and body movements.
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.
The Importance of Antibiotics
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 will usually prescribe an antibiotic such as penicillin for 10 days. Doctors say 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 like 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 worried that some bacteria are becoming resistant to traditional antibiotics. Research is ongoing into the best ways to use antibiotics and to develop new drugs to fight infections also.