Rheumatic fever

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Rheumatic fever
ICD-10 code:	I00-I02
ICD-9 code:	390-392

Rheumatic fever is an inflammatory disease which may develop after an infection with streptococcus bacteria (such as strep throat or scarlet fever) and can involve the heart, joints, skin, and brain.

Contents 1 Causes 2 Symptoms 3 To make a diagnosis 4 Treatment 5 Expectations 6 Complications 7 External link

Causes

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 1950ies, possibly due to higher hygenic 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 occurs seldom, it is serious and has a letality 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. Persons who have suffered a case of rheumatic fever have a tendency to develop flare-ups with repeated strep infections.

Symptoms

• Fever
• Joint pain, migratory arthritis -- involving primarily knees, elbows, ankles, and wrists
• Joint swelling; redness or warmth
• Abdominal pain
• Skin rash (erythema marginatum)
• Skin eruption on the trunk and upper part of arms or legs
• Eruptions that are ring-shaped or snake-like in appearance
• Skin nodules
• Sydenham's chorea
• Epistaxis
• Cardiac (heart) involvement which may be asymptomatic or may result in shortness of breath, and chest pain.

To make a diagnosis

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
    • subacute bakterial endocarditis
    • pericarditis
    • myocarditis
  • Polyarthritis
  • Chorea minor
  • rheumatic erythem
  • knots underneath the skin

• Minor Symptomes
  • Fever
  • Arthralgia
  • increased Erythrocyte sedimentation rate
  • Streptococc infection
  • history of rheumatic fever or rheumatic heart valve defect

Treatment

The management of acute rheumatic fever is geared toward the reduction of inflammation with anti-inflammatory medications such as aspirin or corticosteroids. Individuals with positive cultures for strep throat should also be treated with antibiotics. Another important cornerstone in treating rheumatic fever includes the continuous use of low dose antibiotics (such as penicillin, sulfadiazine, or erythromycin) to prevent recurrence.

Expectations

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.

Complications

• Damage to heart valves (in particular, mitral stenosis and aortic stenosis)
• Endocarditis
• Heart failure
• Arrhythmias
• Pericarditis
• Sydenham's chorea

External link

• NIH Rheumatic fever guide

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