What is Rheumatic Fever

May be obvious to some, the inflammation of the pharynx or tonsils, if not treated an effective treatment can result in injury to the heart of much trouble, rheumatic A fever is only an immune reaction can be followed by inflammation of the pharynx or tonsils, called Streptococcus suis infected with streptococci also affect the joints and inflammation , may also infect the heart muscle.

Appear symptoms of heart failure, and if not effectively addressed, could lead, after years in the injury of heart valve fibrosis and thickening, and subsequent narrowing of the heart valves or leak it, and childhood usually between 5-15 years, while almost which disappear from America and Europe, they still represent a significant medical problem in our country of the Arab Gulf, especially in poor communities with poor nutrition, and living in residential areas are overcrowded and unsanitary.What is rheumatic fever?Beginning signs of rheumatic fever usually after two to three weeks of pharyngitis or tonsillitis, may occur after one week. And cause a rise in temperature, pain and inflammation and swelling in the number of joints, and appear to affected joints red, swollen, hot and painful when the movement. The patient appears pale and sweaty, and usually disappear signs of inflammation in the joints after 42-48 hours, but if the situation is not addressed other joints become inflamed.The more joints involved are the joints of the wrists, elbows, knees and ankles. And rarely get the joints of the hands or fingers of the feet. If the mild attack of rheumatic fever may not look any special symptoms indicate injury to the heart muscle, and this may go undiagnosed.If the attack of rheumatic fever Vtkon severe symptoms are more pronounced, then the patient may complain of shortness of breath when you do the effort, or when it is lying on the bed. It may also appear and edema (swelling) in the legs.If not dealt with bouts of rheumatic fever or repeated occurrence, the greater the risk of injury to the heart valves, where there is fibrosis and thickening of the heart valves leading to the narrowing or leakage. In the West, valve injury occurs after many years of rheumatic heart fever, while in the third world, causing cardiac injury in very early.What about in children rheumatic heart disease?Is the most common types of acquired heart in children and young people common in the Arab world, and is a major cause of mortality and complications attacks in children in the Arab world, for example, statistics indicate that three out of every thousand children in the Kingdom of Saudi Arabia gets rheumatic fever, while affecting five Children of every hundred thousand children in the United States, Europe and Japan, and this is what gives us motivation to fight the disease and eliminate it.How to treat rheumatic fever?Dealing with an attack of rheumatic fever in the comfortable bed to the fever to disappear completely, and return the number of heart rate and ECG, ESR ESR to normal, the patient is given aspirin, may be needed to give the cortisone pills.Is it possible to prevent rheumatic fever?The answer is yes. If treated with tonsillitis or pharyngitis caused by Streptococcus suis address is correct, this is called primary prevention Primary Prevention. Can also stop the development of cardiac injury using intramuscular penicillin long and continuously to prevent any attacks of rheumatic fever, and this so-called «secondary prevention» Secondary Prevention.What are the methods of primary prevention of rheumatic fever?It is known that most cases of throat pain Sore throat caused by a virus. However, 10-20% of cases caused by a type of bacteria called Streptococcus suis streptococci. In fact, it is difficult to differentiate between viral pharyngitis and between bacterial species, but there are some symptoms that may suggest a bacterial cause of pharyngitis or tonsillitis. These symptoms include: a pain suddenly in the throat, headache and fever may be accompanied by pain in the abdomen, nausea, vomiting, and a contract Bulgmah front of the neck, and pus on the tonsils, pharynx, raises the suspicion of why bacterial pharyngitis.Can recognize the presence of bacterial cause of sore throat swab from the throat and planted in the laboratory (farm germs). There is also a special blood test can identify which of a meningococcal infection suis. If this test is positive, or bacterial culture was positive, it should continue antibiotic for ten days.How to treat bacterial pharyngitis?The treatment of bacterial pharyngitis most important step in primary prevention to combat the incidence of rheumatic fever. Penicillin is still the best drug in these cases. Preferably a single dose of penicillin long Benzathin Penicillin IM for children who complain of sore throat when the bacterial culture of throat swab positive.Can be used for penicillin by mouth, or when Ertrohmeysin who are allergic to penicillin for 10 days. It should be emphasized on the need to adhere to this period (10 days), even if symptoms disappear suffered by the patient during the first days of taking medication. And not for the Amoxil Ampicillin or any benefits outweigh the impact of Abannlsin in these cases.How can I prevent the recurrence of rheumatic fever and prevent the development of cardiac injury when one of the wounded heart valves?There is no doubt that the best way to do that is by giving penicillin long Benzathin Penicillin IM once every 3-4 weeks continuously. Can be used for oral penicillin or sulfadiazine or Ertrohmeysin at who has the sensitivity to penicillin.But the use of pills by mouth for years, is less effective in the prevention of attacks of bacterial pharyngitis. If we can prevent repeat attacks of rheumatic fever, 70% of the puffs coronary failure (leakage in the mitral valve), and 72% of the palaces aortic murmurs disappear completely within 10 years, does not occur in the valves have narrowed.How long will long continue to give penicillin IM?There is no agreement among scientists on how long it should continue to give the intramuscular injection of penicillin. The truth is that it depends mainly on whether there is injury attack of rheumatic fever or not. In the event of cardiac injury should use the long IM penicillin injection every 3 weeks and possibly for life, but often the patient to be up to the age of thirty or thirty five.If there were not cardiac injury should be given intramuscular penicillin every 3 weeks for 5 years after an attack of rheumatic fever or perhaps early twenties. It is wise to decide the physician of that period of time depending on the patient's condition and circumstances of the pension and its response to medical follow-up. We still hope to get a vaccine vaccine to prevent rheumatic fever in the near future.What about allergy to penicillin?Concerns of some patients' fears of an injection of penicillin, fear of an allergy to penicillin when the patient, so that those concerns have prevented the patient access to effective treatment for inflammation of the pharynx, also prevented giving the patient and protection enough against rheumatic fever, and although the reactions allergic to penicillin may occur in some patients , but that is rare in those who are given prolonged penicillin intramuscularly every 3-4 weeks. And allergic reaction (eg skin Kalotfh) occurs at about 3% of the people. The shock allergic spoke at 2 per thousand of the cases only.Most of these cases occurred in children over the age of 12 years. Therefore, the benefits of prevention of rheumatic fever and rheumatic heart disease far outweigh the risk of allergic reaction to penicillin. Studies confirmed that 90% of first attacks of rheumatic fever can be prevented if the use of penicillin in the long muscle on a regular basis.



 Dr. Rashid Hamdan FriConsultant Cardiologist and Head of the heart-Jahra Hospital