Rheumatic fever is the disease that most commonly affects school-age children, especially those between 6 and 8 years old. The feature of this disease is usually, but not always, the painful swellingd of some joints. First, a bacterial infection occurs in the throat and is caused by a special strain of streptococci. The body produces specific antibodies to destroy the bacteria, but in some children antibodies also attack the joint tissues as well as (somewhat less) cardiac tissue (sometimes both). Joint inflammation has no long-term effects, but frequent heart inflammation can sometimes cause permanent damage to the heart valves.
A small number of children get rheumatic fever due to streptococcal infections. The inclination of this disease is partially inherited, and it is enhanced if the children are malnourished and live in cold, humid and overcrowded apartments.
Symptoms of rheumatic fever occur 7 to 28 days after the initial sore throat. If the disease affects the joints, one or two joints are reddened, swollen, and painful during the movement (the condition is known as acute rheumatic fever). The child has elevated temperature, loses appetite and feels generally bad and is often pale and sweats. Inflammation usually disappears after approximately 24 hours, but if not treated during that time, other joints may also be temporarily inflammed, usually described as ”moving from one joint to another”. Wrists, elbows, knees and ankles are usually affected. Sometimes the hips and shoulders are inflammed, and fingers on the hands and toes almost never. If only the heart is affected (acute rheumatic carditis), usually in mild cases there are no obvious symptoms. The only symptoms are fatigue, blush and feeling of weakness. These mild cases can be dangerous because parents may think that there is no need to take their children to a doctor, but then the disease can not be diagnosed.
Severe carditis is manifested by very pronounced symptoms; those are usually loss of breath, especially after the effort or while the baby is lying, and accumulation of fluid (edema) on the feet and back.
In some cases od rheumatic fever a rash occurs, usually on the chest, back and abdomen, in the form of reddish circles with pale centers. Their diameter is usually 2 to 3 cm and they are irregular in shape. This rash is not itchy.
Occasionally, nodules or small swellings occur – especially if the heart is affected – just below the skin, on the elbows, knees, wrists and on the back of the head. They are usually round, 5 to 10 mm in diameter, hard and painless.
Today, rheumatic fever is no longer as common as it used to be. In the last 20 years, its frequency decreased by as much as 7 to 8 times, partly due to the treating initial infections with antibiotics and the general improvement in housing, nutrition and hygiene, which reduced the number of pathogens and increased resistance to bacteria.
If is is not a severe form of rheumatic fever, a single attack of this disease will most likely not lead to heart disease (see, for example, mitral stenosis and aortic insufficiency). The risk of heart defects is threatened after repeated (one or more) rheumatic fever attacks. In the past, a recurrence of rheumatic fever occurred more often in children who already had the disease; however, today, after the rheumatic fever seizures, long-lasting treatment with antibiotics are prescribed, thus protecting the child from new streptococcal infections. However, if there are no symptoms of rheumatic fever in a child, there is a risk of heart defect, so contact your doctor whenever the child complains that his throat hurts.
In very severe cases of rheumatic fever, especially when it affects the heart, there is a small risk of cardiac decompensation.
What to do?
If your child shows any of the symptoms described, put him in bed and call a doctor. If a doctor suspects on a rheumatic fever, he will make throat swab and take a blood sample for laboratory testing. The doctor will carefully examine the child and listen to his chest with a stethoscope to find out if the heart is affected.
If the disease is mild, the child can rest at home until the tests shows that the attack has passed.
In more severe cases the child will be received in the hospital. Pain and inflammed joints will rapidly decrease with relatively high doses of aspirin. If the heart is affected, the treatment with the same drug (but at lower doses) is continued once the inflammation is calmed down.
In particularly severe cases, especially if the disease has seriously affected the heart, a treatment of stronger antiinflammatory drugs, sometimes corticosteroids, is being applied. In rare cases of acute heart failure, additional medications (e.g. antiarrhythmics and diuretics) may be used. Whenever the heart is affected, the baby needs to be raised in bed and supported by pillows to make it easier to breathe. In all cases, antibiotics are given to suppress any possible bacteria (residuals due to primary throat infections) and to prevent recurrence of the disease.
Today, the odds for recovery are good. After each rheumatic fever attack, mild or severe, doctors will prescribe antibiotics that are taken every day for years to prevent recurrence. Children, who have had heart failure due to rheumatic fever, will probably be taking antibiotics for a lifetime. In rare cases, however, heart defects develop – usually because no rheumatic fever diagnosis has been set or because recurrence has occurred due to irregular antibiotic use. But, with modern treatment, most patients can live a normal or almost normal life.