Rheumatic fever
Post-streptococcal inflammatory disease / From Wikipedia, the free encyclopedia
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Rheumatic fever (RF) is an inflammatory disease that can involve the heart, joints, skin, and brain.[1] The disease typically develops two to four weeks after a streptococcal throat infection.[2] Signs and symptoms include fever, multiple painful joints, involuntary muscle movements, and occasionally a characteristic non-itchy rash known as erythema marginatum.[1] The heart is involved in about half of the cases.[1] Damage to the heart valves, known as rheumatic heart disease (RHD), usually occurs after repeated attacks but can sometimes occur after one.[1] The damaged valves may result in heart failure, atrial fibrillation and infection of the valves.[1]
Rheumatic fever | |
---|---|
Other names | Acute rheumatic fever (ARF) |
Rheumatic heart disease at autopsy with characteristic findings (thickened mitral valve, thickened chordae tendineae, hypertrophied left ventricular myocardium) | |
Specialty | Cardiology |
Symptoms | Fever, multiple painful joints, involuntary muscle movements, erythema marginatum[1] |
Complications | Rheumatic heart disease, heart failure, atrial fibrillation, infection of the valves[1] |
Usual onset | 2–4 weeks after a streptococcal throat infection, age 5–14 years[2] |
Causes | Autoimmune disease triggered by Streptococcus pyogenes[1] |
Risk factors | Genetics, malnutrition, poverty[1] |
Diagnostic method | Based on symptoms and infection history[3] |
Prevention | Antibiotics for strep throat, improved sanitation[1][4] |
Treatment | Prolonged periods of antibiotics, valve replacement surgery, valve repair[1] |
Frequency | 325,000 children a year[1] |
Deaths | 319,400 (2015)[5] |
Rheumatic fever may occur following an infection of the throat by the bacterium Streptococcus pyogenes.[1] If the infection is left untreated, rheumatic fever occurs in up to three percent of people.[6] The underlying mechanism is believed to involve the production of antibodies against a person's own tissues.[1] Due to their genetics, some people are more likely to get the disease when exposed to the bacteria than others.[1] Other risk factors include malnutrition and poverty.[1] Diagnosis of RF is often based on the presence of signs and symptoms in combination with evidence of a recent streptococcal infection.[3]
Treating people who have strep throat with antibiotics, such as penicillin, decreases the risk of developing rheumatic fever.[4] In order to avoid antibiotic misuse this often involves testing people with sore throats for the infection; however, testing might not be available in the developing world.[1] Other preventive measures include improved sanitation.[1] In those with rheumatic fever and rheumatic heart disease, prolonged periods of antibiotics are sometimes recommended.[1] Gradual return to normal activities may occur following an attack.[1] Once RHD develops, treatment is more difficult.[1] Occasionally valve replacement surgery or valve repair is required.[1] Otherwise complications are treated as usual.[1]
Rheumatic fever occurs in about 325,000 children each year and about 33.4 million people currently have rheumatic heart disease.[1][7] Those who develop RF are most often between the ages of 5 and 14,[1] with 20% of first-time attacks occurring in adults.[8] The disease is most common in the developing world and among indigenous peoples in the developed world.[1] In 2015 it resulted in 319,400 deaths down from 374,000 deaths in 1990.[5][9] Most deaths occur in the developing world where as many as 12.5% of people affected may die each year.[1] Descriptions of the condition are believed to date back to at least the 5th century BCE in the writings of Hippocrates.[10] The disease is so named because its symptoms are similar to those of some rheumatic disorders.[11]