What are the symptoms of rheumatic fever and its risks

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What are the symptoms of rheumatic fever and its risks

The rheumatic fever It is an inflammatory, systemic disease, secondary to an autoimmune reaction to the streptococcal infection produced at the level of the upper airways.

Cause of rheumatic fever

The agent cause of rheumatic fever It is group A beta hemolytic streptococcus.

After pharyngeal infection, components of the bacteria are released that can generate antigenic determinants (epitopes) in other human tissues, so an autoimmune process with multi-organ involvement (heart, nervous system, and joints) can develop.

Symptoms of rheumatic fever

The symptoms of the rheumatic fever it occurs after a latency period (from the infection until it produces symptoms), approximately 2 to 3 weeks. General symptoms that may occur include:

  • Fever: It can be high or moderate, greater than 38.5 degrees Celsius, lasting several days (between 10 to 15).
  • Tiredness, physical and mental fatigue.
  • Arthritis (inflammation in joints): It is one of the most frequent symptoms, affecting 75% of patients. It is characterized by being polyarticular, with an acute and insidious onset, asymmetric with migration of the affected joints and it has a predilection for the lower limbs and large joints, before manifesting itself in the upper limbs. You can remit without sequelae.
  • Arthralgia (joint pain): equally frequent and occurs in several joints at the same time.
  • Adynamia (muscle weakness): it is characterized by the patient in whom weakness and fatigue reach such a point that he is prostrate or it is difficult for him to react with movements.
  • Hypo or anorexia (loss of appetite and food intake).
  • Myocarditis, pericarditis, or endocarditis: inflammation of the different areas of the heart, both its external envelope (pericarditis), as well as the myocardial muscle (myocarditis) and the cardiac interior (endocarditis), for which the patient may manifest symptoms associated with heart failure and present heart murmurs on physical examination. (on auscultation) due to valvular alterations such as mitral regurgitation and aortic insufficiency. It has a latency period of approximately 3 weeks, you can also see expressed changes in the electrocardiogram.
  • Syndenham’s Chorea (also known as San Vito disease or Rheumatic Korea) is an infectious disease of the central nervous system secondary to rheumatic fever in only 2% of cases, which can occur months after the initial history of pharyngotonsillitis, and consists of uncontrollable and spasmodic contractions of various muscle groups, lacking in efficiency (clumsiness) and similar to fasciculations, which make movements look like of uncontrolled dance (hence the name Korea and Syndenham in honor of the English doctor who described the disease). Grimaces, character changes, irritability and sudden changes in mood (going from crying to laughing or vice versa) can also be observed.
  • subcutaneous nodules: They are painless mobile and small masses (less than 2cm), not attached to deep planes, which appear on the extension surface of the joints.
  • Marginal erythema: of infrequent appearance in 5% of cases, it appears in the arms or trunk, but does not usually give symptoms on the face. It consists of an evanescent, pinkish, nonpruritic (non-stinging) rash with irregular edges and healthy-looking skin in the center.
  • Abdominal pain that could resemble other entities such as appendicitis.

Diagnosis of Rheumatic Fever

There is currently no clinical or laboratory test to confirm the presence of rheumatic fever.

Diagnosis is based on clinical suspicion and the criteria (major and minor) of the World Health Organization, in the context of a previous infection by group A beta-hemolytic streptococcus.

The usual clinical picture is preceded, in approximately 3 weeks, by pharyngotonsillitis, with tonsillar redness, with or without exudate, petechiae (red dots) on the palate, swollen submaxillary or laterocervical lymph nodes, pain when swallowing, fever and abdominal pain, subsequently appearing the symptoms described above typical of the disease.

Risks of the symptoms of Rheumatic Fever.

The rheumatic fever it can have a different intensity and evolution from patient to patient, ranging from pure joint forms to more complex and severe presentations with isolated chorea or carditis or associations of various symptoms.

The severity of rheumatic fever It is determined by the cardiac sequelae that could occur if cardiac and valvular integrity is compromised, as well as at the neurological level, after the presentation of symptoms compatible with Syndenham’s chorea.

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