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Rheumatic fever

Category: Illness or disabilities

Type

Involuntary

Introduction and description

Rheumatic feveris an inflammatory disease that occurs following a Streptococcus pyogenes infection, such as streptococcal pharyngitis or scarlet fever. It is caused by antibody cross-reaction that can involve the heart, joints, and skin .  The illness is so named because of its similarity in presentation to rheumatism. 

Rheumatic fever primarily first affects children between ages 5 and 17 years and occurs approximately 20 days after strep throat. In up to a third of cases, the underlying strep infection may not have caused any symptoms. 

Rheumatic fever is common worldwide and responsible for many cases of damaged heart valves. In Western countries, it has become less common due to the widespread use of antibiotics. Although the disease seldom occurs in the west, it is serious and has a case-fatality rate of 2–5%. 

Unless treated it recurs.  The incidence of recurrence with a subsequent untreated infection is substantially greater.  People who have suffered a case of rheumatic fever have a tendency to develop flare-ups with repeated strep infections.  The recurrence of rheumatic fever is relatively common in the absence of maintenance of low dose antibiotics, especially during the first three to five years after the first episode. 

Heart complications may be long-term and severe, particularly if valves are involved.

Symptoms

Not all symptoms may be present, but these are the main ones 

  • Inflammation of joints and chronic pain - A temporary migrating inflammation of the large joints, usually starting in the legs and migrating upwards.
  • Inflammation of the heart muscle (myocarditis) which can gives the same symptoms as congestive heart failure  - shortness of breath,  heart pain, heart murmur, palpitations etc
  • Subcutaneous nodules: Painless, firm collections of collagen fibers over bones or tendons (like rheumatism) on the back of the wrist, the outside elbow, or the front of the knees.
  • Fever of 38.2–38.9 °C (101–102 °F)
  • Severe Joint pain without swelling 
  • Abdominal pain
  • Nose bleeds
  • A long-lasting reddish rash - that begins on the trunk or arms , spreads outward and clears in the middle to form rings, which continue to spread and coalesce with other rings, ultimately taking on a snake-like appearance. This rash typically spares the face and is made worse with heat.
  • St. Vitus' dance [see separate entry]: A characteristic series of rapid movements without purpose of the face and arms. This can occur very late in the disease for at least three months from onset of infection.

Causes

The body produces antibodies that attack  the cell wall of Streptococcus, however the antibodies may also react against the myocardium and joints, producing appalling pain in the joints in general similar to rheumatism.  The same bacteria  can contain a protein called the  M protein and the  antibodies which the immune system generates against the M protein may cross react with the cardiac myofiber protein myosin, the heart muscle and the arteries causing tissue destruction.  In effect, rheumatic fever can leave you with a severely damaged heart – a debilitating heart condition. 

Treatment

These days rheumatic fever can [theoretically] be treated.   The approach is symptom based.

Doctors use Aspirin and Corticosteriods [in quite high doses] are used to reduce the inflammation and then low-dose antibiotics (such as penicillin, sulfadiazien or erythromycin) to prevent recurrence.  Monthly injections of long acting penicillin must be given for a period of five years.

Ibuprofen is used for the pain.  

Steroids are reserved for cases where there is evidence of involvement of the heart. The use of steroids may prevent further scarring of tissue and may prevent development of sequelae such as mitral stenosis.  If there is evidence of carditis, the length of therapy may be up to 40 years. If the person develops heart failure, then they are given ACE inhibitors, diuretics, beta blockers and digoxin.

How it works

Fever of itself can produce a spiritul experience [see hyperthermia and fever]Extreme pain can also give you a spiritual experience and the heart problems may cause Hypotension  - low blood pressure – all of which work via hypoxia.  Along with this low blood pressure the person may get the additional symptoms of  exhaustion and fatigue.

See also Bacterial infection.

Observations

The person whose experiences I am going to draw on most for this section is Saint Teresa of Avila.  There are a huge number of experiences in her book “The Life of Saint Teresa of Avila by Herself” as such this is only a small selection.  The interpretation Teresa places on these experiences might, in some cases, be different if analysed today, nevertheless the experiences are extremely vivid and interesting.

Related observations