You can get rheumatic fever from congested places

Sometimes when children develop a sore throat, some parents tell them to gurgle salt. This may soothe the symptoms for a while but the bacteria will continue eating up the throat. Rheumatic fever is an inflammatory disease that can develop as a complication of inadequately treated strep throat.

Strep throat is caused by an infection with group A streptococcus bacteria. If untreated, an infection such as ‘strep throat’ may lead to a delayed complication, featuring widespread inflammation in other parts of the body, particularly the joints, heart, skin and brain.

According to Dr Judith Namuyonga, a paediatric cardiologist at Uganda Heart Institute in Mulago, children between five and 14 years are at increased risk of developing Rheumatic fever. Without treatment, the disease can lead to serious complications such as rheumatic heart disease.

She says, two out of seven children have rheumatic heart disease which is a result of a reoccurrence of rheumatic fever.
The disease can also attack adults who stay in very congested areas and symptoms include a fever and difficulty swallowing, and 17 per cent of adults die in their first year of diagnosis.

What really happens?
The link between strep infection and rheumatic fever is not clear, but it appears that the bacterium tricks the immune system. The strep bacterium has a similar structure to one found in certain tissues of the body.
Dr Namuyonga says, “The immune system cells that would normally fight the bacterium, fight the body’s own tissues as if they were infectious agents. Here, the tissues of the heart, joints, skin and central nervous system get destroyed. This immune system reaction results in inflammation.”

Risk factors
According to Dr Isaac Ssinabulya, an adult cardiologist at Uganda Heart Institute, some people carry a gene that makes them more susceptible to developing rheumatic fever.
He says, “Environmental factors that are a great risk of rheumatic fever include overcrowding, poor sanitation and other conditions that can easily result in the rapid transmission or multiple exposures to strep bacteria.”

Rheumatic fever remains common in many developing nations among people of low social class because they live in congested places with poor ventilation. She says, “Staying in a crowded, congested area where there is poor air circulation puts one at risk of catching it because the bacteria that causes rheumatic fever thrives in such an environment.”

Symptoms
• Fever, fatigue.
• Painful and inflamed joints.
• Difficulty in swallowing anything, including saliva.
• Breathlessness.
• Chest pain.
• Unexplained weight loss.
• Nervous system problems, such as involuntary movements and twitches.
• Rapid heartbeat or heart murmur.

Effects
Dr Namuyonga advises that, “All sore throats get treated because the bacteria once not treated can eat up into the heart. If not treated over time, rheumatic heart fever can cause rheumatic heart disease which weakens the functioning of the heart by destroying its muscles and valves.”
The knees, ankles, elbows, and wrists are the joints most likely to become swollen from rheumatic fever. The pain often migrates from one joint to another.

However, the greatest danger from the disease is the damage it can do to the heart.
She says, “If you have a severe sore throat without other cold symptoms or a fever and it persists for more than three days, it is advisable to see a doctor immediately. Also try to avoid congested places and open all windows if you are so many in a room to allow proper circulation of air.”

“Treatments can reduce tissue damage from inflammation, lessen pain and other symptoms, and prevent the recurrence of rheumatic fever. It can be treated by a monthly penicillin injection and depending on the severity of the problem; the patient may be treated from hospital or as an outpatient,” says Dr Ssinabulya.

Treatment
According to the Children’s Hospital of Wisconsin website, the best treatment for rheumatic heart disease is prevention. Children who have previously contracted rheumatic fever are often given continuous (daily or monthly) antibiotic treatments to prevent future attacks of rheumatic fever and lower the risk of heart damage.
If inflammation of the heart has developed, children may be given medications to reduce the inflammation, as well as antibiotics to treat the Streptococcus infection.

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