Alternative names: Febris rheumatica
Category disease: Bacterial diseases
Branch curing this disease: Cardiology and other
Description of rheumatic fever
Rheumatic fever is a dangerous inflammatory disease that develops as a complication of poorly treated or even untreated streptococcal tonsillitis caused by streptococcus A. It is primarily a disease of childhood, most patients are between five and fifteen. In developed countries, relative to the good availability of antibiotic treatment of this disease is currently quite rare, but in developing countries is still a major problem.
Even in our environment but its consequences are evident among the older generation who had undergone angina at times without antibiotics.
Risk of rheumatic fever resides mainly in damage to the heart, which causes the inflammation, may also develop inflammation of the pericardium and especially inflammation of the flap, which develops so-called nonbacterial rheumatic endocarditis, which significantly affects the heart and in the late stages can lead to heart failure.
Risk factors
As with a number of other diseases is a very important risk factor for the occurrence of the disease in the family, both parents or grandparents, since it is assumed that exists for the disease-specific gene that causes the individual has more prerequisites for this disease. Another factor is the exposure, the specific type streptococci, since of course all of these types of bacteria are not as aggressive. Greater risk of infection and then developing rheumatic fever in crowded places with poor hygiene and the like, which is greatly facilitated the spread of infection.
Prevention of rheumatic fever
Prevention of rheumatic fever is especially timely in the deployment of antibiotic treatment in the early streptococcal tonsillitis. It is necessary to adhere to dosing schedules and antibiotics always good to end to ensure that the disease is actually cured. From doctors to prescribe antibiotics, it is necessary to wisely and for other diseases so as to avoid bacterial resistance, which then could backfire even just the outbreak of rheumatic fever.
Signs and symptoms of rheumatic fever
The mechanism of acute rheumatic fever is still somewhat unclear, but doctors are inclined to the theory that streptococci actually deceives the immune system. On their surface because they have a protein that is similar to the proteins of various body parts. Therefore, immune cells that would normally of course, immediately attacked the bacteria can attack against its own cells and tissues as if they were infections. These tissues are mainly cardiac tissue, joints, central nervous system and the skin. This reaction, which is also called cross-reactions, causing the development of inflammation.
The symptoms are very diverse, both in their quality and quantity. Speeches are very individual.They result from streptococcal afflicted joints, heart, skin and central nervous system. For about two weeks after a history of angina occurs first signs of the disease such as fatigue, fever, high pain, tenderness, swelling and redness in various joints in the phone typically knees, elbows, ankles and wrists, but also the small joints of the hands and feet or the the shoulder and hip. Important is that difficulties are migratory, they can start in one joint and from there spread to other, prior to disappear and so forth. Under the skin to form a stiff painless palpable nodules formed collagen-over bones or tendons, especially the wrist, elbow and knee. The patient feels a sudden intense severe palpitations and breathing difficulties accompanied by chest pain. On the skin of the trunk and the hand appears rash that protrudes slightly above the surface of the skin, but it does not hurt and has a slightly frayed edge, gradually spreads further and is worsened by the action of heat. Central nervous system is reflected externally as a special uncontrollable movements especially the hands and feet (Sydenham’s chorea or St. Vitus’s dance) accompanied by bursts of unpredictable and abnormal behavior, bouts of crying or laughing. A possible side-effect may be epistaxe- therefore nosebleed, abdominal pain and various character.
Of rheumatic fever point and lab results, such as increased erythrocyte sedimentation, increased C reactive protein (typically when inflammation), increased number of white blood cells, fever,increased Antistreptolysin O and ECG changes.
Examination
The doctor patient always removes history and perform basic physical examination, according to the majority already visible symptoms of rheumatic fever can be diagnosed. Notes in particularchanges in joint mobility, to search for signs of inflammation, palpation examined for the presence of characteristic skin nodules, listen to heart that they secure any abnormalities murmur or arrhythmia, and asks the patient to execute the various movements to be able to assess the condition of the central nervous system. Further, the clinician may remove blood, which is then looking in the blood circulating antibodies against streptococci, since bacteria themselves have long levels are not. It is also possible in blood found elevated levels of C reactive protein (typically when inflammation), increased number of white blood cells, increase Antistreptolysin O and can detect an increased erythrocyte sedimentation.
The patient may be sent on the ECG, which is clearly prolonged PR interval due to damage to the heart, and an echocardiogram, which is an imaging technique in which a plural view of the heart and to search for pathological changes.
Therapy
To put rheumatic fever handle, you need to start antibiotic treatment leveled against streptococci, so if laboratory tests are still detected its presence. Furthermore, it is desirable to mitigate ongoing inflammation using a variety of anti-inflammatory agents such as aspirin common in worse cases to corticosteroids which prevents further zajizvování tissues. After a period of five years, patients received injections of long-acting penicillin.
If you are affected and heart, the treatment may take up to forty years. It is also often necessary long-term low-dose penicillin antibiotics or macrolides (erythromycin) to prevent recurrence of the disease. When non doses of antibiotics or stopping the disease often returns, usually in three to five years after the first episode.
It is recommended bed rest and total peace until the early symptoms of inflammation subsided and the patient’s condition does not improve. If heart disease is bed rest absolutely indispensable and strict, even for a few months.
Often it is necessary to deploy drugs for managing chorea, when the doctor prescribes called anticonvulsants, thus anticonvulsants such as valproate or carbamazepine.
It is clear that the patient will need medical care after mastering the acute symptoms of the disease, mainly because of heart problems, for example, to take a long time, for several years. Sick must regularly go to the control and be monitored closely after-treatment.
What can I do for myself
After the outbreak of acute rheumatic fever is primarily necessary to conserve globally, be calm, at least in the beginning, but even more, lie in bed and thereby promote faster healing and also prevent further, more serious damage organs.
Complication
The inflammation caused by the disease can last for varying periods, from several weeks to several months. In some cases, this inflammation can leave an additional consequences and complications.
Dangerous complication is obviously rheumatic heart damage, especially the valves. The most commonly damaged heart valve is bicuspid or mitral valve, which separates the left atrium and ventricle. Damage to the valves can manifest as mitral stenosis, a narrowing of the valve, which further results in reduced blood flow and slow. Mitral insufficiency is contrary expansion valve, which allows blood flowed in the wrong direction, thus retroactively. Damaged but on the heart may not be only the flap may be affected and the entire cardiac muscle that ongoing inflammation can weaken so that it completely significantly weaken its function as a blood pump. After a few years, these problems may unfortunately result in further deterioration and for example atrial fibrillation. Atrial fibrillation is a condition in which there is very rapid and irregular download muscle fibrillation.
Longer duration of these problems can lead to heart failure, when the heart loses its ability to distribute blood throughout the body.
Other names: Febris rheumatica