Developments in Brief : Rheumatic Fever Cases Stir Renewed Concern

A recent outbreak of rheumatic fever in Utah demonstrates that the disease “remains an important threat” in the United States, despite a dramatic decline in the number of cases over the last 30 years, doctors warned.

Researchers at the University of Utah Medical School said their findings show vigilance is still needed to combat the disease, which usually develops in children with strep throat and can cause life-threatening heart disorders. “Rheumatic fever is still a problem,” Dr. Herbert D. Ruttenberg said. “We want to make the physicians around the country aware of this.”

Although a significant problem in developing countries, the incidence of rheumatic fever has dropped significantly in the United States, prompting many health officials to argue that it is no longer necessary to take throat cultures on all children with severe sore throats to look for strep throat, or to always treat strep throat with penicillin.

The disease is marked by fever, pain and swelling of the joints and a variety of complications, including arthritis and inflammation of the heart that can cause permanent damage to heart valves and sometimes death. Doctors suspect rheumatic fever causes immune systems of victims to malfunction, attacking the joints, the heart and sometimes the brain.

Normally, the Primary Children’s Medical Center in Salt Lake City sees about six cases of rheumatic fever each year. But from January, 1985, until June, 1986, 74 cases were reported. In addition, Ruttenberg said, the outbreak has continued since his report was submitted to the New England Journal of Medicine. More than 90 cases have now been diagnosed, he said. Thirteen of the patients suffered congestive heart failure, and two required heart valve replacement surgery.

Although rheumatic fever typically affects children from low-income backgrounds, most of the children in the study were from middle-class families with above-average incomes and easy access to medical care.