Rhumatic fever - definition of Rhumatic fever in the Medical dictionary - by the Free Online Medical Dictionary, Thesaurus and Encyclopedia.

Rheumatic Fever

Definition

Rheumatic fever (RF) is an illness which arises as a complication of untreated or inadequately treated strep throat infection. Rheumatic fever can seriously damage the valves of the heart.

Description

Throat infection with a member of the Group A streptococcus (strep) bacteria is a common problem among school-aged children. It is easily treated with a ten-day course of antibiotics by mouth. However, when such a throat infection occurs without symptoms, or when a course of medication is not taken for the full ten days, there is a 3% chance of that person developing rheumatic fever. Other types of strep infections (such as of the skin) do not put the patient at risk for RF.

Children between the ages of five and fifteen are most susceptible to strep throat, and therefore most susceptible to rheumatic fever. Other risk factors include poverty, overcrowding (as in military camps), and lack of access to good medical care. Just as strep throat occurs most frequently in fall, winter, and early spring, so does rheumatic fever.

Causes and symptoms

Two different theories exist as to how a bacterial throat infection can develop into the disease called rheumatic fever. One theory, less supported by research evidence, suggests that the bacteria produce some kind of poisonous chemical (toxin). This toxin is sent into circulation throughout the bloodstream, thus affecting other systems of the body.

Research seems to point to a different theory, however. This theory suggests that the disease is caused by the body's immune system acting inappropriately. The body produces immune cells (called antibodies), which are specifically designed to recognize and destroy invading agents; in this case, streptococcal bacteria. The antibodies are able to recognize the bacteria because the bacteria contain special markers called antigens. Due to a resemblance between Group A streptococcus bacteria's antigens and antigens present on the body's own cells, the antibodies mistakenly attack the body itself.

It is interesting to note that members of certain families seem to have a greater tendency to develop rheumatic fever than do others. This could be related to the above theory, in that these families may have cell antigens which more closely resemble streptococcal antigens than do members of other families.

In addition to fever, in about 75% of all cases of RF one of the first symptoms is arthritis. The joints (especially those of the ankles, knees, elbows, and wrists) become red, hot, swollen, shiny, and extraordinarily painful. Unlike many other forms of arthritis, the arthritis may not occur symmetrically (affecting a particular joint on both the right and left sides, simultaneously). The arthritis of RF rarely strikes the fingers, toes, or spine. The joints become so tender that even the touch of bedsheets or clothing is terribly painful.

A peculiar type of involuntary movement, coupled with emotional instability, occurs in about 10% of all RF patients (the figure used to be about 50%). The patient begins experiencing a change in coordination, often first noted by changes in handwriting. The arms or legs may flail or jerk uncontrollably. The patient seems to develop a low threshold for anger and sadness. This feature of RF is called Sydenham's chorea or St. Vitus' Dance.

A number of skin changes are common to RF. A rash called erythema marginatum develops (especially in those patients who will develop heart problems from their illness), composed of pink splotches, which may eventually spread into each other. It does not itch. Bumps the size of peas may occur under the skin. These are called subcutaneous nodules; they are hard to the touch, but not painful. These nodules most commonly occur over the knee and elbow joint, as well as over the spine.

The most serious problem occurring in RF is called pancarditis ("pan" means total; "carditis" refers to inflammation of the heart). Pancarditis is an inflammation that affects all aspects of the heart, including the lining of the heart (endocardium), the sac containing the heart (pericardium), and the heart muscle itself (myocardium). About 40-80% of all RF patients develop pancarditis. This RF complication has the most serious, long-term effects. The valves within the heart (structures which allow the blood to flow only in the correct direction, and only at the correct time in the heart's pumping cycle) are frequently damaged during the course of pancarditis. This may result in blood which either leaks back in the wrong direction, or has a difficult time passing a stiff, poorly moving valve. Either way, damage to a valve can result in the heart having to work very hard in order to move the blood properly. The heart may not be able to "work around" the damaged valve, which may result in a consistently inadequate amount of blood entering the circulation.

Diagnosis

Diagnosis of RF is done by carefully examining the patient. A list of diagnostic criteria has been created. These "Jones Criteria" are divided into major and minor criteria. A patient can be diagnosed with RF if he or she has either two major criteria (conditions), or one major and two minor criteria. In either case, it must also be proved that the individual has had a previous infection with streptococcus.

The major criteria include:

carditis
arthritis
chorea
subcutaneous nodules
erythema marginatum

The minor criteria include:

fever
joint pain (without actual arthritis)
evidence of electrical changes in the heart (determined by measuring electrical characteristics of the heart's functioning during a test called an electrocardiogram, or EKG)
evidence (through a blood test) of the presence in the blood of certain proteins, which are produced early in an inflammatory/infectious disease.

Tests are also performed to provide evidence of recent infection with group A streptococcal bacteria. A swab of the throat can be taken, and smeared on a substance in a petri dish, to see if bacteria will multiply and grow over 24-72 hours. These bacteria can then be specially processed, and examined under a microscope, to identify streptococcal bacteria. Other tests can be performed to see if the patient is producing specific antibodies; that are only made in response to a recent strep infection.

Treatment

A 10-day course of penicillin by mouth, or a single injection of penicillin G-is the first line of treatment for RF. Patients will need to remain on some regular dose of penicillin to prevent recurrence of RF. This can mean a small daily dose of penicillin by mouth, or an injection every three weeks. Some practitioners keep patients on this regimen for five years, or until they reach 18 years of age (whichever comes first). Other practitioners prefer to continue treating those patients who will be regularly exposed to streptococcal bacteria (teachers, medical workers), as well as those patients with known RF heart disease.

Arthritis quickly improves when the patient is given a preparation containing aspirin, or some other anti-inflammatory agent (ibuprofen). Mild carditis will also improve with such anti-inflammatory agents, although more severe cases of carditis will require steroid medications. A number of medications are available to treat the involuntary movements of chorea, including diazepam for mild cases, and haloperidol for more severe cases.

Prognosis

The long-term prognosis of an RF patient depends primarily on whether he or she develops carditis. This is the only manifestation of RF which can have permanent effects. Those patients with no or mild carditis have an excellent prognosis. Those with more severe carditis have a risk of heart failure, as well as a risk of future heart problems, which may lead to the need for valve replacement surgery.

Prevention

Prevention of the development of RF involves proper diagnosis of initial strep throat infections, and adequate treatment within 10 days with an appropriate antibiotic. Prevention of RF recurrence requires continued antibiotic treatment, perhaps for life. Prevention of complications of already-existing RF heart disease requires that the patient always take a special course of antibiotics when he or she undergoes any kind of procedure (even dental cleanings) that might allow bacteria to gain access to the bloodstream.

Resources

Organizations

Centers for Disease Control and Prevention. 1600 Clifton Rd., NE, Atlanta, GA 30333. (800) 311-3435, (404) 639-3311. http://www.cdc.gov.

Key terms

Antibodies — Specialized cells of the immune system which can recognize organisms that invade the body (such as bacteria, viruses, and fungi). The antibodies are then able to set off a complex chain of events designed to kill these foreign invaders.

Antigen — A special, identifying marker on the outside of cells.

Arthritis — Inflammation of the joints.

Autoimmune disorder — A disorder in which the body's antibodies mistake the body's own tissues for foreign invaders. The immune system therefore attacks and causes damage to these tissues.

Chorea — Involuntary movements in which the arms or legs may jerk or flail uncontrollably.

Immune system — The system of specialized organs, lymph nodes, and blood cells throughout the body, which work together to prevent foreign invaders (bacteria, viruses, fungi, etc.) from taking hold and growing.

Inflammation — The body's response to tissue damage. Includes hotness, swelling, redness, and pain in the affected part.

Pancarditis — Inflammation of the lining of the heart, the sac around the heart, and the muscle of the heart.

fever /fe·ver/ (fe´ver)

1. pyrexia; elevation of body temperature above the normal (37°C).

2. any disease characterized by elevation of body temperature.

blackwater fever a dangerous complication of falciparum malaria, with passage of dark red to black urine, severe toxicity, and high mortality.

boutonneuse fever a tickborne disease endemic in the Mediterranean area, Crimea, Africa, and India, due to infection with Rickettsia conorii, with chills, fever, primary skin lesion (tache noire), and rash appearing on the second to fourth day.

cat-scratch fever see under disease.

central fever sustained fever resulting from damage to the thermoregulatory centers of the hypothalamus.

childbed fever puerperal septicemia.

Colorado tick fever a tickborne, nonexanthematous, febrile, viral disease caused by an arenavirus and seen in the Rocky Mountain area of the United States.

continued fever one that varies only slightly in 24 hours.

Crimean-Congo hemorrhagic fever a hemorrhagic fever caused by the Crimean-Congo hemorrhagic fever virus, transmitted by ticks and by contact with blood, secretions, or fluids from infected animals or humans; it occurs in the Crimea, Central Asia, and regions of Africa.

drug fever febrile reaction to a therapeutic agent, such as a vaccine, antineoplastic, or antibiotic.

elephantoid fever a recurrent acute febrile condition occurring with filariasis; it may be associated with elephantiasis or lymphangitis.

enteric fever any of a group of febrile illnesses associated with enteric symptoms caused by salmonellae, especially typhoid fever and paratyphoid fever.

epidemic hemorrhagic fever an acute infectious disease characterized by fever, purpura, peripheral vascular collapse, and acute renal failure, caused by viruses of the genus Hantavirus, thought to be transmitted to humans by contact with saliva and excreta of infected rodents.

familial Mediterranean fever a hereditary disease usually seen in Armenians and Sephardic Jews, with short recurrent attacks of fever, pain in the abdomen, chest, or joints, and erythema like that of erysipelas; it may be complicated by amyloidosis.

Haverhill fever the bacillary form of rat-bite fever, due to Streptobacillus moniliformis, and transmitted through contaminated raw milk and its products.

hay fever a seasonal form of allergic rhinitis, with acute conjunctivitis, lacrimation, itching, swelling of the nasal mucosa, nasal catarrh, and attacks of sneezing, an anaphylactic or allergic reaction excited by a specific allergen (such as pollen).

hemorrhagic fevers a group of diverse, severe viral infections seen around the world but mainly in the tropics, usually transmitted to humans by arthropod bites or contact with virus-infected rodents; they all have certain common features, including fever, hemorrhagic manifestations, thrombocytopenia, shock, and neurologic disturbances.

humidifier fever malaise, fever, cough, and myalgia caused by inhalation of air that has been passed through humidifiers, dehumidifiers, or air conditioners contaminated by fungi, amebas, or thermophilic actinomycetes.

intermittent fever an attack of malaria or other fever, with recurring fever episodes separated by times of normal temperature.

Katayama fever fever associated with severe schistosomal infections, accompanied by hepatosplenomegaly and by eosinophilia.

Lassa fever a highly fatal, acute, febrile disease seen in West Africa, caused by a virulent arenavirus and characterized by increasing prostration, sore throat, ulcerations of the mouth or throat, rash, and general aching.

metal fume fever a disease of welders and others working with volatilized metals, marked by sudden thirst, metallic taste in the mouth, high fever with chills, sweating, and leukocytosis.

mud fever a type of leptospirosis seen in workers in flooded fields and swamps in Germany and Russia.

nonseasonal hay fever , hay fever, perennial nonseasonal allergic rhinitis.

Oroya fever see Carrión's disease.

paratyphoid fever paratyphoid.

parenteric fever a disease clinically resembling typhoid fever and paratyphoid, but not caused by Salmonella.

parrot fever psittacosis.

pharyngoconjunctival fever an epidemic disease due to an adenovirus, seen mainly in school children, with fever, pharyngitis, conjunctivitis, rhinitis, and enlarged cervical lymph nodes.

phlebotomus fever a febrile viral disease of short duration, transmitted by the sandfly Phlebotomus papatasi, with dengue-like symptoms, seen in Mediterranean and Middle Eastern countries.

Pontiac fever a self-limited disease marked by fever, cough, muscle aches, chills, headache, chest pain, confusion, and pleuritis, caused by a strain of Legionella pneumophila.

pretibial fever an infection due to a serovar of Leptospira interrogans, marked by a rash on the pretibial region, with lumbar and postorbital pain, malaise, coryza, and fever.

puerperal fever septicemia accompanied by fever, in which the focus of infection is a lesion of the mucous membrane of the parturient canal due to trauma during childbirth; usually due to a streptococcus.

Q fever a febrile rickettsial infection, usually respiratory, first described in Australia, caused by Coxiella burnetii.

rat-bite fever either of two clinically similar acute infectious diseases, usually transmitted through a rat bite, one form (bacillary) of which is caused by Streptobacillus moniliformis and the other form (spirillary) by Spirillum minor.

recurrent fever

1. relapsing f.

2. recurrent paroxysmal fever occurring in various diseases, such as malaria.

relapsing fever any of a group of infectious diseases due to various species of Borrelia, marked by alternating periods of fever and apyrexia, each lasting from five to seven days.

remittent fever one that shows significant variations in 24 hours but without return to normal temperature.

rheumatic fever a febrile disease occurring as a sequela to Group A hemolytic streptococcal infections, characterized by multiple focal inflammatory lesions of connective tissue structures, especially of the heart, blood vessels, and joints, and by Aschoff bodies in the myocardium and skin.

Rift Valley fever a zoonotic febrile disease with dengue-like symptoms, due to an arbovirus, transmitted to humans by mosquitoes or by contact with diseased animals; first observed in the Rift Valley, Kenya.

Rocky Mountain spotted fever infection with Rickettsia rickettsii, transmitted by ticks, marked by fever, muscle pain, and weakness followed by a macular petechial eruption that begins on the hands and feet and spreads to the trunk and face, with other symptoms in the central nervous system and elsewhere.

rose fever a form of hay fever caused by grass pollens released while roses or other flowers are blooming.

scarlet fever an acute disease caused by Group A β-hemolytic streptococci, marked by pharyngotonsillitis and a skin rash caused by an erythrogenic toxin produced by the organism; the rash is a diffuse, bright red erythema, and desquamation of the skin begins as fine scaling with eventual peeling of the palms and soles.

Sennetsu fever a febrile disease seen in Japan and Malaysia and caused by Ehrlichia sennetsu, characterized by headache, nausea, lymphocytosis, and lymphadenopathy.

septic fever fever due to septicemia.

South African tickbite fever boutonneuse f.

trench fever a louse-borne rickettsial disease due to Bartonella quintana, transmitted by the body louse, Pediculus humanus corporis, and characterized by intermittent fever, generalized aches and pains, particularly severe in the shins, chills, sweating, vertigo, malaise, typhus-like rash, and multiple relapses.

typhoid fever infection by Salmonella typhi chiefly involving the lymphoid follicles of the ileum, with chills, fever, headache, cough, prostration, abdominal distention, splenomegaly, and a maculopapular rash; perforation of the bowel may occur in untreated cases.

fever of unknown origin (FUO) a febrile illness of at least three weeks' duration (some authorities permit a shorter duration), with a temperature of at least 38.3°C on at least three occasions and failure to establish a diagnosis in spite of intensive inpatient or outpatient evaluation (three outpatient visits or three days' hospitalization).

West Nile fever see under encephalitis.

yellow fever an acute, infectious, mosquito-borne viral disease, endemic primarily in tropical South America and Africa, marked by fever, jaundice due to necrosis of the liver, and albuminuria.

rheumatic fever

n. Abbr. RF

An acute inflammatory disease occurring during recovery from infection with group A streptococci, having an onset marked by fever and joint pain. It is associated with polyarthritis, Sydenham's chorea, and endocarditis, and is frequently followed by scarring of the heart valves.

rheumatic fever (rf),

a systemic inflammatory disease that may develop as a delayed reaction to an inadequately treated infection of the upper respiratory tract by group A beta-hemolytic streptococci. The disease usually occurs in young school-age children and may affect the brain, heart, joints, skin, or subcutaneous tissues. Also called acute articular rheumatism. See also rheumatic heart disease.

observations The onset of rheumatic fever is usually sudden, often occurring 1 to 5 symptom-free weeks after recovery from a sore throat or scarlet fever. Early symptoms generally include fever, joint pain, nosebleeds, abdominal pain, and vomiting. The major manifestations of this disease include migratory polyarthritis affecting numerous joints and carditis, which causes palpitations, chest pain, and, in severe cases, symptoms of cardiac failure. Sydenham's chorea is usually the sole late sign of rheumatic fever and may initially be manifested as an increased awkwardness and tendency to drop objects. As the chorea progresses, irregular body movements may become extensive, occasionally involving the tongue and facial muscles, resulting in incapacitation. Other developments may include transient erythema marginatum with circular lesions and subcutaneous rheumatic nodules on various joints and tendons, the spine, and the back of the head. There is no specific diagnostic test for rheumatic fever. The development of serum antibodies to streptococcal antigens is a positive diagnostic sign. Affected individuals may also develop leukocytosis, moderate anemia, and proteinuria. C-reactive protein, evaluated in a specimen of blood, is abnormally high in concentration. Recurrences of rheumatic fever are common. Except for carditis, all the manifestations of the disease usually subside without any permanent effects. Mild cases may last 3 to 4 weeks. Severe cases with associated arthritis and carditis may last 2 to 3 months.

interventions Management of rheumatic fever includes bed rest and severe restriction of normal activity. Penicillin is often administered, even if throat cultures are negative, and steroids or salicylates may be used, depending on the severity of any associated carditis and arthritis.

nursing considerations Symptoms largely determine the type of nursing care. The nurse is alert to signs of toxicity associated with salicylate, steroid, and antibiotic therapies. The nurse also monitors the patient's fluid status with regard to cardiac function, helps minimize joint pains by properly positioning the patient, and gives emotional support.

fever (pyrexia)

(pīrek´sē

),
n an elevation of the body temperature.

hand-foot-and-mouth fever, aphthous,

n See disease.

fever, cat-scratch,

n See disease, cat-scratch.

fever, hay,

n rhinitis and conjunctivitis resulting from allergy; frequently caused by allergy to pollens.

fever, of unknown origin,

n the persistent elevation of body temperature without an identifiable cause.

fever, rheumatic

n a severe, apparently infectious disease produced by hemolytic streptococci organisms or associated with their presence in the body; characterized by upper respiratory tract inflammation, cervical lymphadenopathy and lymphadenitis, polyarthritis, cardiac involvement, and subcutaneous nodules. The disease may be produced by an autoantibody reaction.

fever, scarlet (scarlatina),

n an acute disease caused by a specific type of
Streptococcus organism and characterized by a rash and strawberry tongue.

fever, uveoparotid (Heerfordt's syndrome, uveoparotitis)

n 1. a disease characterized by inflammation of the parotid gland and of the uveal regions of the eye.
2. the firm, nodular enlargement of the parotid glands, uveitis, and cutaneous lesions may be present. Considered to be a form of sarcoidosis.
3. a syndrome consisting of sarcoidosis affecting the parotid glands, inflammation of the lacrimal glands, and inflammation of the uveal tract of the eye.