ACUTE REHUMATIC FEVER

Acute rheumatic fever usually affects children or young adults and has become very rare in Western Europe and North America. The condition is triggered by an immune –mediated delayed response to infection with specific strains of group .A streptococci that posses antigens which may cross-react with cardiac myosin and membrane protein. Antibodies produced against the streptococcal antigens mediate inflammation in the endocardium as well as the joints and skin. Symptoms are characteristically occurring 2-3 weeks after the initial attack but the patients may give no history of sore throat. Echocardiography typically shows dilution of the mitral annulus and other common findings are aortic regurgitation and pericardial effusion. A single dose of benzyl penicillin should be given diagnosis to eliminate any residual streptococcal infection. If the patient is penicillin –allergic erythromycin is used. Treatment is then directed towards limiting cardiac damage and relieving symptoms. Bed rest is important as it lessens joint pain and reduces cardiac workload. The duration of bed rest should be guided by symptoms and markers of inflammation and should be continued until these have settled. Cardiac failure should be treated as necessary. If the heart failure does not respond to medical treatment in these cases, valve replacement may be necessary and is often associated with dramatic decline in rheumatic activity. Patients with residual heart disease prophylaxis should continue until 10 years after the episode or 40years of age, whichever is longer.