Acute rheumatic fever

Rheumatic Fever: See main article: Rheumatic Fever

Acute: An acute condition is newly arising, sudden, rather than long-lasting or recurring ("chronic"). Doesn't always mean severe although it often is. See: Acute, Acute Disorders

Rheumatic fever: See main article: Rheumatic fever

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Acute rheumatic fever is a disease that can occur following an infection caused by the Group A streptococcus bacterium. If untreated, a 'strep throat' infection can lead to inflammation in other parts of the body, particularly the joints, brain and heart. Without regular antibiotic treatment, further attacks of rheumatic fever can lead to serious damage of the heart valves. This is known as rheumatic heart disease.

Source: Queensland Health1

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Acute rheumatic fever (ARF) is a delayed complication of an untreated throat infection from Group A Streptococcus bacteria. Inflammation caused by ARF can cause permanent damage to the heart muscle or heart valves and reduce the ability of the heart to pump blood effectively around the body; this is known as rheumatic heart disease.

Source: Australian Institute of Health and Welfare2

Symptoms of Acute rheumatic fever

Signs and Symptoms

The typical initial symptoms include:

  • fever
  • malaise (feeling generally quite unwell)
  • painful, swollen joints (which may present as sudden refusal to bear weight or to use a limb)
  • unusual jerky movements.

Source: Queensland Health3

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Clinical description

ARF is an autoimmune consequence of a throat infection caused by the bacterium GAS, that is, Streptococcus pyogenes. It causes an acute generalised inflammatory response and an illness that affects only certain parts of the body, mainly the heart, joints, brain and skin. All suspected cases of ARF should be referred to hospital for specialist assessment, investigation, education and treatment.

Source: Communicable Disease Control Manual 2012, New Zealand Health4

Treatments for Acute rheumatic fever

Specific treatment includes:

  • aspirin (or another anti-inflammatory drug) to relieve painful swelling of the joints
  • penicillin (usually given by injection) to ensure that any remaining 'strep' bacteria are cleared
  • bed rest may be required for those with severe rheumatic heart disease.

Source: Queensland Health5

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Treatment

Ideally all those with suspected ARF (first episode or recurrence) should be hospitalised as soon as possible after onset of symptoms, and should be under the care of a specialist paediatrician or physician. The main priority in the first few days after presentation is confirmation of the diagnosis. The treating clinician is responsible for treatment, prophylaxis, education, dental referral, notification to public health, and informing the case’s general practitioner.

Treatment options for arthritis/arthralgia, fever, carditis/heart failure and chorea are outlined in the New Zealand Guidelines for Rheumatic Fever: 1. Diagnosis, management and secondary prevention (National Heart Foundation 2006).

One episode of rheumatic fever significantly increases the risk of further episodes, often with further cardiac damage. Antibiotic prophylaxis to prevent recurrent attacks of rheumatic fever should therefore be started before discharge from hospital. The appropriate duration of secondary prophylaxis depends on a number of factors, including age, clinical pattern, environment and time elapsed since the last episode of ARF.

All cases should receive regular primary care review, and outpatient follow-up should be initiated before discharge from hospital.

Source: Communicable Disease Control Manual 2012, New Zealand Health6

Preventions for Acute rheumatic fever

Prevention

It is essential that anyone who has had an episode of acute rheumatic fever, or that person's parents or guardian, are made fully aware of the disease, and the importance of preventing damage to the heart valves.

The most important measure to prevent further strep throats (and therefore further attacks of acute rheumatic fever) is regular antibiotic therapy, preferably a monthly injection of penicillin. These injections will need to be continued for many years, until a specialist doctor advises that they can be stopped. It is also very important that someone who has had acute rheumatic fever receives regular medical and dental checkups.

A coordinated approach is essential for the effective long-term management of acute rheumatic fever and rheumatic heart disease patients. For this reason, a Rheumatic Heart Disease Register and Control Program has been established in Queensland. This program has five coordinators situated throughout Queensland.

Source: Queensland Health7

Related Symptoms

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References

  1. Source: Queensland Health: conditions.health.qld.gov.au/ HealthCondition/ condition/ 14/ 33/ 160/ acute-rheumatic-fever
  2. Source: Australian Institute of Health and Welfare: aihw.gov.au/ reports-statistics/ health-conditions-disability-deaths/ heart-stroke-vascular-diseases/ about
  3. Source: Queensland Health: conditions.health.qld.gov.au/ HealthCondition/ condition/ 14/ 33/ 160/ acute-rheumatic-fever
  4. Source: Communicable Disease Control Manual 2012, New Zealand Health: health.govt.nz/ publication/ communicable-disease-control-manual-2012
  5. Source: Queensland Health: conditions.health.qld.gov.au/ HealthCondition/ condition/ 14/ 33/ 160/ acute-rheumatic-fever
  6. Source: Communicable Disease Control Manual 2012, New Zealand Health: health.govt.nz/ publication/ communicable-disease-control-manual-2012
  7. Source: Queensland Health: conditions.health.qld.gov.au/ HealthCondition/ condition/ 14/ 33/ 160/ acute-rheumatic-fever
  8. [from HPO]
  9. Source: GTR (NCBI/NIH): ncbi.nlm.nih.gov/ gtr/ conditions/ C0239998/ 
  10. Source: RDCRN (NCATS/NIH): rarediseasesnetwork.org/ cms/ cegir/ Learn-More/ Glossary

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Note: This site is for informational purposes only and is not medical advice. See your doctor or other qualified medical professional for all your medical needs.