Rheumatic fever is the commonest cause of heart disease in the young population under age of 40. Both male and female are equally affected. When it affects the heart, it may damage , the valves leading to rheumatic heart diseases.
It's associated with streptococcus bacteria which produce toxins which lead to the damage of various organs of the body. This association is particularly important, because an attack of rheumatic fever is often followed by two weeks of sore throat or tonsillitis due to this bacteria.
Overcrowding encourages the spread of this bacteria, hence, it's found in densely populated areas with poor ventilated houses. Any depressing cause such as overwork or anxiety may precipitate an attack in persons prone to them. Attacks of rheumatic fever may fallow exposure to cold and damp and this is more common in the cold season.
Those who have suffered from this disease are likely to be attacked again. Each recurrence damages the heart valve even more.An attack of rheumatic fever begins with chilliness followed by fever. Your temperature is usually elevated to about 39.5o C.
The joints such as the knee, ankle, wrist or shoulder and the lower limbs are usually swollen, tender, warm to touch and painful. At first, the pain is confined to only one or two joints, but soon, others become affected.
Other symptoms of acute rheumatic fever include coated tongue, loss of appetite, abdominal pains and migratory rash (usually with red raised margin) that appears on the trunk or limbs.
The management of acute rheumatic fever is based on 3 principles: Bed rest, Antibiotics and steroids or Aspirin.
Bed rest: The severely attacked persons should be hospitalized and given bed rest. The benefit of bed rest is to reduce the risk of severe heart diseases. Bed rest should be short (3-4 weeks) and the child can return to school but should be restricted from physical education and highly competitive sports for another 4 weeks.
Antibiotics: Penicillin is the drug of choice in suspected cases but erythromycin is an alternative drug in persons who are sensitive to penicillin.
Aspirin: are useful in treatment of inflammatory processes. They relieve pain and swelling of the joints and reduce fever. Aspirin dosage is given in the first week and half of this dose in subsequent weeks. Steroids medication is given to persons who do not respond to aspirin and those with acute congestive heart failure. As withdrawal of steroids is accompanied by recurrence of symptoms, it's advisable to combine steroids with aspirin. Pednisolone is the steroids commonly used and it is adjusted according to age of the affected persons for 10 days.
Good education, reduced overcrowding, improved housing and nutrition are some of the general methods used to stop acute rheumatic fever. Another specific method comprise treatment of streptococcal sore throats against streptococcal infection. Streptococci sore throats should be treated using penicillin for 7-10 days.Tonsillitis should be kept in check, which if not addressed will act as the most important predisposing factor.
It's not always easy to ascertain streptococcal throat infection, but this can be done on a clinical basis where throat cultures are not available. Persons with previous attacks of acute rheumatic fever should receive antibiotic prophylaxis so as to prevent further damage to the heart valves. Long-acting benzathine penicillin should be given every month. Small children should be given half of this dosage i.e 0.6 mega units monthly. People who are allergic to penicillin should be given erythromycin 250 mg orally twice weekly as the alternative drug.
Ensure prophylaxis is continued all the way through childhood to early adulthood (18-24 years of age) when the risk of damage to heart valves becomes less. Continued intake should be encouraged as long as there are active features of the disease.
Note: Parents, make sure you administer the penicillin monthly and take your kid(s) for regular check-ups and administration of drugs.