Rheumatic Fever

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Definition Aetiology Pathophysiology Risk factor Sign and Symptoms Investigations Management

Definition

Rheumatic fever is an inflammatory disease that can develop as a complication of group A streptococcal pharyngitis (strep throat) that has not been adequately treated. It can affect the heart, skin, brain, and other organs and is characterised by fever, joint pain, and swelling.

Aetiology

A consequence of inadequately treated pharyngitis.
In susceptible individuals, streptococcal infection initiates an autoimmune response that attacks healthy tissues in the joints, heart, skin, brain, and other organs.
Genetic factors
Environmental factors: includes overpopulation, poor sanitation, and poverty.

Pathophysiology

When a person has a strep infection, the bacteria produce an antigen similar to the human antigen.
In susceptible individuals, the immune response that targets both the antigen of the bacteria and the individual's own antigen causes damage and inflammation.
The immune response will cause swelling and pain in the joints.
In the heart, the immune response causes inflammation of the heart muscle (myocarditis) and inflammation of the heart's sac (pericarditis), which, if untreated, can result in heart failure.

Risk factors

Age: Children between the ages of 5 and 15 are at highest risk
Genetics factors
Previous history of rheumatic fever
Poor living conditions
Lack of timely treatment for streptococcal pharyngitis
Other medical conditions: such as systemic lupus erythematosus (SLE)

Sign and symptoms

The symptoms usually occur around 1-5 weeks after a streptococcal infection

Joint pain and swelling
Fever
Skin rash: small red, slightly raised skin lesions may appear on the trunk and extremities.
Chest pain, palpitations, shortness of breath, and fatigue.
Chorea: a rapid, jerky, involuntary movements of the face, limbs, and trunk.
Abdominal pain, nausea and vomiting.
Headache

Investigations

Blood tests: high levels of antistreptolysin O (ASO) antibodies + erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP).
Electrocardiogram (ECG): a prolonged P-R interval can be observed
Echocardiogram: might display inflammation, valve damage, or fluid around the heart.
Throat culture: can be used to confirm the presence of group A streptococcus to help guide antibiotic treatment.

Management

Antibiotics: Penicillin is the first-line antibiotics. For example, benzylpenicillin 600mg IV (hospital), followed by penicillin V 250mg.
Anti-inflammatory medications: aspirin or nonsteroidal anti-inflammatory drugs (NSAIDs) to reduce inflammation and relieve pain. Corticosteroids can be considered in severe inflammation.
In cases of severe cases hospitalisation may be necessary for supportive care and monitoring.