Rheumatic Fever on Rise Again, but Shouldn’t Be

For the past few years rheumatic fever has been on the rise, triggered by a common infection: strep throat.

Millions of children get streptococcal bacterial infections of the throat each year, but only a few will go on to develop rheumatic fever.

Rheumatic fever usually strikes children between the ages of 5 and 15. But it only occurs in people who are susceptible to what is called an “autoimmune” reaction by the body which is triggered by the strep bacteria.

There are several strains of strep, but the bacteria responsible for most cases of rheumatic fever is Group A streptococcus.

Usually, a susceptible child will have the symptoms of strep throat: a raw, inflamed throat and a high fever. Within a week to 10 days, the child will develop a usually transient form of arthritis with inflamed, swollen and painful joints, fever, occasionally skin rashes or sometimes abnormal muscle movements.

While these symptoms clear up within a few weeks, the inflammation can leave lasting damage to the heart.

The long-term consequences of the disease include congestive heart failure due to damage to the heart muscle.

In about 50% of cases, patients also suffer damage to the valves on the left side of the heart, the mitral valve and the aortic valve.

Leakage as a result of damaged heart valves can be life-threatening to a few patients later in life, with some eventually needing surgery to replace damaged valves with artificial ones.

Fortunately, rheumatic fever can be prevented by antibiotic prophylaxis.

But it is important that any severe sore throat accompanied with fever be medically evaluated and a throat culture taken.

If the throat culture proves positive, the strep infection is treated with a 10-day course of antibiotics, usually penicillin, which reduces the risk of developing rheumatic fever.

Even though symptoms of the infection can clear up quickly, it’s important that the treatment be continued for the full 10 days, since the infection could recur.