How congestion may trigger rheumatic fevers

Gurgling salt is one of the commonest natural remedies for a sore throat. The remedy may soothe the symptoms sometimes but there are times when the problem is bigger than just a sore throat because the bacteria may continue eating up your throat until it reaches the lungs and affect the heart.
Rheumatic fever is a disease that occurs following an infection caused by bacterium in the throat. The inflammatory disease can develop as a complication of inadequately treated sore throat caused by Group A streptococcus bacteria.
If untreated, an infection such as ‘strep throat’ may lead to complications, including widespread inflammation in other parts of the body, particularly the joints, heart, skin and brain.

Dr Judith Namuyonga, a paediatric cardiologist at Uganda Heart Institute (UHI) in Mulago, says adults and children between five and 14 years are at increased risk of developing rheumatic fever. Without treatment, the disease can lead to rheumatic heart disease.
She says many children have rheumatic heart disease as a result of a reoccurrence of rheumatic fever and the prevalence is high in low social economic status schools.
“The disease can also attack adults that stay in very congested houses and the fever starts mildly with difficulty in swallowing,” she says.

What happens?
The link between strep infection and rheumatic fever is not clear, but it appears that the bacterium tricks the immune system (inflammation). The strep bacterium has a similar structure to one found in certain tissues of the body, which becomes hard for the body to fight without medication.
Dr Namuyonga says: “The immune system cells that would normally fight the bacterium end up fighting 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 into inflammation.”

Risk factors
Dr Isaac Ssinabulya, a cardiologist at UHI, says some people carry a gene that makes them more susceptible to developing rheumatic fever which runs in their families.
He says: “Environmental factors such as poor sanitation are a greater risk of rheumatic fever because there is rapid transmission or multiple exposures to strep bacteria to the people living in such areas.”
Rheumatic fever remains common in many developing nations among people of low social class because they live in congested places with poor ventilation.
Dr Ssinabulya says: “Staying in a congested area where there is poor air circulation puts one at the risk of catching it because the bacteria that causes rheumatic fever thrives in such an environment.”
Namuyonga advises: “If sore throats are not treated, over time, rheumatic heart fever can cause rheumatic heart disease, which weakens the functioning of the heart, thereby destroying its muscles and valves.
“Treatments reduce tissue damage, lessen pain and prevent recurrence.”

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