Rheumatic Fever By - Naren

Ravi

What is the disease RF? - Rheumatic fever can be explained in simple terms as a
progression of a bacterial infection which leads to multiple symptoms. The symptoms can be
related to the Joints, heart and can manifest neurologically. Skin as well

How did the child get the disease? – So this infection arises due to a group if bacteria
named strep pyrogens. This usually starts as a throat infection and if left alone without any
treatment it can progress to a severe case. The link between the strep infection and
rheumatic fever isn’t clear but it appears that the bacteria tricks the bodies immune system.
In short, the body attacks the bacteria along with other parts of the body. (heart, joints, skin
and CNS). This causes the inflammation of the organs.

What are symptoms of the disease? – The onset of the disease usually begins 2 – 4 weeks
after a strep infection of the throat. I can split the symptoms according to the organ it
affects. In general, your child will be suffering with a fever, will feel tired and be suffering
with pain in the joints. If it affects the heart the child will have murmurs and maybe chest
pain. The joints that are usually affected are the elbows, knees, ankles and the wrist
(big/large joints) migratory pain should be mentioned. If it’s the skin, there’ll be a slightly
raised, painless rash (round). There could also be painless bumps on the surface of the skin.
The neurological symptoms would be uncontrollable jerking movements of the arms and
sometimes you might notice outbursts or unusual behaviours such as crying or
inappropriate laughing . (chorea) – handwriting is changing

Will child need tests? – Yes definitely. Laboratory evidence of a preceding strep infection is
needed whenever possible. We as physicians follow something called JONES criteria. So to
place your child under this criteria which is his first attack it would involve the presence of 2
major manifestations or 1 major and 1 minor manifestation. In labs the presence of high
titers of anti-streptolysin O can confirm the diagnosis. Chest radiograph could (less
informative, only in case pericarditis) be used to check if the heart is in inflammation. We
will also perform Echocardiography with Doppler to assess the valves of the heart. This is
the gold standard test. This is used by physicians who are experts in this field. ECG is very
important, CBC as well

How is the disease treated and where? – The primary method is to eradicate the infection.
This can be done by starting with antibiotics penicillin to be exact. This treatment is injected
intramuscularly once a week till the fourth week.?? 4 times? In acute period If there is heart
involvement the drug should be continued for longer periods of time. Prophylaxis can
continue for upto 5 years (sometimes more) till the symptoms completely resolve. Pain can
be reduced with the help of aspirin. Your child would need bed rest and need not stay in the
hospital if medications are taken well. In severe cases steroids are used

When to call for an ambulance? - As I said earlier the the bacteria can affect the heart. So if
your child complains of chest pain or any shortness of breath after 3-4 weeks from today
always consider to call the ambulance.

Is there anything that parents can do to make the child feel better before a visit to doctor?
– Its always better to treat the throat infection as soon as possible as it usually causes
irritation for the child.

Can the disease be prevented? - Yes. The disease can be treated. If the throat infection(or
any skin infection) is treated on time with the help of the medications mentioned, the
disease can be prevented. Emphasize antibiotic penicillin for 10 days