Breaking News:

Rheumatic fever often affects central nervous system

.
Rheumatic fever is an inflammatory disease that can happen after a person becomes infected with the Streptococcus bacteria.  Rheumatic fever was once a common cause of heart problems in childhood. It remains a serious childhood health problem in many developing countries. In North America, it's become much less common due to improved hygiene and routine use of antibiotics for infections. When it does strike, however, it can still have serious consequences for heart health.
Rheumatic fever is most frequent in children aged 5 to 15 years old, but can also affect adults and children younger than 5 years of age. However, there are no reliable figures on adults.
Rheumatic fever is caused by a combination of bacterial infection and immune system overreaction. It almost always follows a strep throat infection, which is an infection of the respiratory tract caused by bacteria of the Streptococcus family. Children are far more likely to get strep throat than adults.
Normally, Streptococcus causes a cough and a sore throat, and clears up with antibiotics. In some cases, however, children with strep throat begin complaining of pain in the joints or other unusual symptoms. This usually happens 2 to 4 weeks after the streptococcal infection (which may have already cleared up).
The disease has an affinity for the joints, the central nervous system (brain and spinal cord), and the heart. In the heart, the disease can affect the inner lining of the heart including the heart valves (endocarditis), the muscle of the hear (myocarditis), or the covering of the heart (pericarditis).
In some people, the body reacts with a massive immune system reaction to the affected areas. The cells that normally kill invading bacteria become so active that they also attack the affected tissues. The result in the joints is temporary arthritis (inflammation of the joints). In the heart, they can permanently damage heart valves, increasing the risk of heart problems later in life. Rheumatic fever can also cause problems with the nervous system that are usually reversible.
The symptoms of rheumatic fever depend on whether the heart, joints, or nervous system are affected. Most people with rheumatic fever have fever and joint pain. The joint pain (arthritis) usually affects large joints such as the knees, elbows, ankles, or wrists. The joint pain characteristically migrates from one joint to another, so that one or more joints may be swollen, red, and extremely tender. The arthritis is usually reversible.
Many people who develop rheumatic fever suffer damage to the muscle tissue of the heart, which may include their heart valves (endocarditis), heart muscle (myocarditis), sac covering the heart (pericarditis), or all three. This may cause no symptoms, but some people feel heart palpitations or chest pain. Occasionally, there is heart failure, though few people in North America die during a rheumatic fever episode.
In severe cases, the valves have to be replaced with artificial ones. People with damaged valves and those with an artificial heart valve are at increased risk of a heart infection later in life (infectious endocarditis).
The central nervous system may also be affected to produce a symptom known as chorea. Chorea affects females more frequently and almost never occurs after puberty. The onset of chorea is usually gradual, and it often first appears several months after the rheumatic fever has passed. Occasionally, chorea is the only visible symptom of rheumatic fever. Teachers may be the first to notice it and mistake it for clumsiness or restlessness. Symptoms of chorea may include:
grimacing
muscular weakness
involuntary, purposeless movements of the arms and legs
emotional disturbances (crying and restlessness)
Rheumatic fever can also cause skin lesions to develop. These can be firm and painless nodules under the skin that can be present for one or more weeks, or non-itching rashes (called erythema marginatum) that usually affect the trunk of the body and appear and disappear within hours.
How is rheumatic fever treated?
The first step in treating rheumatic fever is to eradicate the bacteria which initially caused the immunologic response. This is usually accomplished with the use of penicillin. For penicillin-allergic patients, there are other options such as erythromycin (E-Mycin, Eryc, Ery-Tab, PCE, Pediazole, Ilosone) or azithromycin (Zithromax, Zmax). It is important to make sure that the acute infection is treated, but such treatment won't necessarily change the course of rheumatic fever once the immunologic response has begun.. Your doctor will decide on the best treatment option for you. The joint pains are treated with aspirin or aspirin-related medications. It may be necessary to use very high doses to decrease the symptoms.
Carditis is treated by high-dose steroids but other cardiac medications may be needed to control the inflammation of the heart. This is a serious condition and is most often initially managed in an acute-care setting such as a hospital.
The most difficult and unpredictable symptom to treat is the chorea (involuntary movements).
It often responds to antipsychotic medications such as haloperidol (Haldol) but may continue for a protracted period. For patients who develop Sydenham's chorea, it can be the most difficult of the symptoms, since it involves involuntary movements and can interfere with daily activities.
These individuals must remain on chronic long-term antibiotics to prevent recurrence of the strep infection, which has been known to cause recurrence of the chorea.