Rheumatic fever

It is the end of summer vacation and a 10-year-old girl is outside playing when her mother notices the jerky and uncontrolled movements of her usually coordinated daughter. Earlier in the summer the girl had complained of a sore throat and later she had shown a skin rash for a day or two. When the girl saidthat her knee ached, her mother dismissed these complaints as "growing pains." Could these simple ailments be connected? This young girl is showing symptoms of rheumatic fever, a disease that usually affects young people aged fiveto 15 and girls more frequently than boys. Symptoms often manifest themselves in late summer or early fall if a child has had a throat infection in the spring or early summer.

The disease begins as a bacterial infection such as strep throat caused by Group A streptococcus bacteria. To combat the infection, the human body produces antibodies which fight the bacteria. These antibodies then seem to turn onthe body, attacking and inflaming healthy connective tissues of the joints, brain, and heart. What results may be a fever, inflammation of the joints (sometimes incorrectly called " growing pains"), and Sydenham's chorea--uncontrollable, spastic movements (traditionally called St. Vitus' Dance) caused by the immune system disorder's affect on the nervous system. By far the most dangerous and long-lasting effect of rheumatic fever can be permanent damage to the heart. Cardiac tissue, especially the heart valves, may become thickened and scarred, leading to the narrowing or leaking of heart valves, heart murmur, or even heart failure.

Much of what is known about the bacteria that cause rheumatic fever is from work done by Dr. Rebecca Craighill Lancefield of the Rockefeller Institute. Lancefield was a pioneer in classifying the chains of round bacteria known as streptococci. In her laboratory during the 1920s, she identified many types ofstreptococci and saw the connection between rheumatic fever and Group A streptococcus. However, she was frustrated in her efforts to discover how the bacteria cause the disease. Why they prompt such a destructive immune system response still remains a mystery.

After Lancefield's work, and with the coming of the age of antibiotics, penicillin was used to effectively treat rheumatic fever, and still is today. If the initial strep throat infection is treated with antibiotics, the disease cannot progress; however, without treatment, perhaps one percent of cases willdevelop into rheumatic fever. In conjunction with antibiotics, aspirin therapy is recommended to counteract joint pain and minimize heart damage. Sometimes a child with rheumatic fever continues to take penicillin over a long period of time to prevent recurrence.

Rheumatic fever had almost disappeared in the United States by the early 1980s--only 88 cases were recorded in 1983 as compared to 10,000 in 1961. However, in 1985, two hospitals in Utah alone reported 150 new cases, and outbreakshave since been reported in several other states. Also, the current strain appears to be more likely to cause heart damage because strep symptoms are muchless severe, often being mistaken for a simple cold or other respiratory infection. In the developing countries of Asia and Africa, the disease is more common. There is no vaccine to prevent rheumatic fever, nor is there a cure once it develops.

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