Acute Rheumatic Fever - Symptoms, Risk factors and Treatment

Acute rheumatic fever is an infection that occurs after getting infected with an untreated or under-treated streptococcal infection such as strep throat or scarlet fever. As an immune system response, the body may damage the heart valves. It is an inflammatory condition that damages the connective tissues of joints, skin, brain, and most commonly heart. Over time, the heart valves can become scarred due to prolonged inflammation, hence, their ability to function well is compromised. 



Symptoms 


The signs and symptoms of rheumatic fever vary in severity. A person may have only some symptoms or may have many. It can cause;


  • Pain in one joint that migrates to another 

  • Red, hot or swollen joints

  • Small, painless bumps beneath the skin

  • Fever

  • Painful and tender joints — most often in the knees, ankles, elbows, and wrists

  • Chest pain

  • Heart murmur

  • Fatigue

  • Flat or slightly raised, painless rash with a ragged edge

  • Sydenham chorea- Jerky, uncontrollable body movements — most often in the hands, feet, and face

  • Outbursts of unusual behavior, such as crying or inappropriate laughing that accompanies Sydenham chorea


Causes 


Rheumatic fever is caused by streptococci bacteria.


The streptococci are a group of bacteria causing different clinical diseases. They produce Illnesses by releasing toxins or by a delayed antibody-mediated response, which is a condition in which your body starts hurting your own tissues while fighting off the bacteria. Streptococci are divided into different groups such as:


  • Group A Streptococci ( Streptococcus pyogenes)

  • Group B streptococci ( Streptococcus agalactiae)

  • Group D streptococci ( Enterococci and Non-enterococci)

  • Streptococcus Viridans

  • Streptococcus Pneumoniae


Group A Streptococci is responsible for causing rheumatic fever. 



Group A streptococci are also called streptococcus pyogenes which means pus-producing. This group causes a variety of diseases by local invasion or toxin release or by a delayed antibody-mediated response such as:


  • Streptococcal pharyngitis (Sore throat)

  • Folliculitis (infection of hair follicles)

  • Cellulitis ( Infection of skin cells)

  • Erysipelas (Infection of superficial skin layer)

  • Impetigo ( Blisters around the mouth)

  • Necrotizing Fasciitis ( Damage to soft tissues)

  • Scarlet fever

  • Rheumatic fever

  • Acute-post streptococcal glomerulonephritis



Rheumatic fever may occur after getting infected with an untreated or under-treated streptococcal infection such as strep throat or scarlet fever. As an immune system response, the body may also damage the heart valves. It is an inflammatory condition that damages the connective tissues of joints, skin, brain, and most commonly, the heart. 


Strep infections like strep throat, which occur most commonly in children, if left untreated or under-treated can become a source of rheumatic fever. Therefore, if your child is suffering from a recurrent sore throat, you must take them to a healthcare provider.


Complications 


The inflammation due to rheumatic fever may remain for some weeks to several months. In some cases, it may cause rheumatic heart disease- a condition in which damage of heart valves occurs. 



The signs and symptoms of rheumatic heart disease are;

 

  • Cough

  • Breathlessness

  • Weakness and fatigue

  • Increased sweating

  • High heart rate (Tachycardia)

  • Deep breathing

  • Faster breathing (Tachypnea)

  • Unintentional weight loss

  • Pale skin 

  • Fever or chills 

  • Heart murmur- an abnormal sound of turbulent blood flow through the heart that a healthcare provider can hear through a stethoscope. 



The symptoms of rheumatic heart disease may occur 10 to 20 years later of getting infected with rheumatic fever. It may cause complications like;


Valve stenosis- narrowing of the heart valves

Valve regurgitation- a leakage in the valve that causes backflow of blood

Endocarditis- inflammation of the inner layer of the heart that can spread to other layers of the heart as well, causing myocarditis and/or pericarditis. 



Conclusion 


Acute rheumatic fever is an infection that occurs after getting infected with an untreated or under-treated streptococcal infection such as strep throat or scarlet fever. If your child suffers from recurrent throat infections, take them to a healthcare provider and get them treated. If left untreated, they can turn into rheumatic fever, which can, in turn, cause rheumatic heart disease.


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