Rheumatic fever

The characteristics of rheumatic fever are inflammation reactions around the joints and heart. The disease can occur in association with streptococcal pharyngitis; in about 1 per cent of patients with a streptococcal infection the reaction between the bacteria and the body’s defence mechanism is abnormally violent, and symptoms of rheumatic fever occur within 1 to 3 weeks. The most important symptom is a shifting inflammation of the joints: a number of large joints such as the knees, ankles and shoulders become inflamed successively, with associated pain, swelling and redness. Each joint remains inflamed for three to seven days, then the symptoms move on. Small, painless bumps occur around the joints under the skin, and there is usually high fever. In roughly half the cases the heart also becomes inflamed (carditis), affecting the inner lining and the cardiac muscles. Cardiac inflammation causes rapid and/or irregular heartbeat, abnormalities in the electrocardiogram and in serious cases heart failure4’. Inflammation of the lining of the heart can cause irreparable damage to the heart valves, but this occurs in less than half of those in which the heart becomes inflamed. The mitral valve is the most frequently affected, the aortic valve less often. Scar tissue forms in the affected valve over several years, and eventually the valve cannot close properly and leaks, causing a heart murmur. Rheumatic fever is treated with antibiotics, aspirin and corticosteroids. In the acute phase monthly injections of penicillin should be administered for at least five years to avoid recurrent strep-

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