Rheumatic fever hard to diagnose, even with test

Donya Betancourt, Pediatrician, Sanur, Bali, drdonya@hotmail.com

If you or your child have symptoms of rheumatic fever, diagnosis involves a physical examination and questions regarding your symptoms. No laboratory test can confirm that you have rheumatic fever.

Rheumatic fever can be difficult to diagnose and doctors base diagnosis of rheumatic fever on the presence of several major and minor criterion.

The most common important signs are pain and swelling of joints that migrate from joint to joint, and inflammation of the heart. Diagnosing rheumatic fever requires not only the presence of key symptoms but also the evidence of a recent strep infection.

However, it is possible that by the time you see your doctor, your throat culture test for strep will be negative. In that case, the only suggestion of strep may be your telling your doctor about a recent sore throat accompanied by fever.

Treatment of rheumatic fever involves antibiotics to rid your body of streptococcal infection and prevent recurrences, and other medications to ease the symptoms of the disease.

Your doctor may prescribe penicillin or another antibiotic. Usually the patients who have experienced a documented acute rheumatic fever attack should receive continuous antibiotic prophylaxis to prevent streptococcal infections at least until reaching adulthood or at least five years after their most recent attack.

The heart inflammation from rheumatic fever does not always result in permanent damage. However, one or more of the heart's valves may be scarred. Permanent heart damage due to rheumatic fever is known as rheumatic heart disease. Patients whose acute rheumatic fever attack has left them with damaged heart tissue may need lifelong antibiotic prophylaxis.

Prevention of rheumatic fever involves prompt, accurate diagnosis and effective treatment of streptococcal pharyngitis. A sore throat with fever lasting for longer than 24 hours may indicate a strep infection. Although most of the time strep throat doesn't lead to rheumatic fever, you can prevent rheumatic fever by using antibiotics to treat strep throat or consult a doctor if you have recently had a sore throat and high fever.

The last complication that involves strep infection is post- streptococcal glomerulonephritis, which is still common in Asia.

Acute glomerulonephritis currently is described as a clinical syndrome that frequently manifests as a sudden onset of hematuria (blood in the urine appears as red or cola-colored urine), proteinuria (blood protein in urine) and red cell casts (red blood cells that have leaked through the glomeruli and have reached the tubule, where they develop into cylindrical forms), which can be detected when the urine is examined under a microscope.

Each kidney is composed of about one million microscopic filtering "screens" known as glomeruli that selectively remove waste products. This cleansing system breaks down and the inflammatory process usually begins with infection or injury.

For post-strep glomerulonephritis, the incubation period generally is between one and two weeks for the post-pharyngitis form of the disease, and four to six weeks in the case of post- dermal (skin) infection.

Most of the patient are boys, aged two to 14 years, who suddenly develop puffiness of the eyelids and facial edema especially periorbital (around the eyes). There is no specific treatment that will make the filters heal faster. The treatment is aimed at controlling the symptoms, the most dangerous of which are severe high blood pressure and kidney failure. Treatment involves specific medication and supportive therapy to prevent and treat the consequences, such as edema, hypertension, and progression of renal disease.

While antibiotic therapy should be administered to abolish the streptococcal infection, no evidence indicates that such therapy influences the course of glomerulonephritis. Patient education is very important. The abnormal urinalysis may persist for years especially hematuria (blood in urine). Strenuous exercise should be avoided and added salt should be avoided in the diet until edema, hypertension, and azotemia (impaired renal function) clear.

Protein should be restricted if there is the presence of azotemia and metabolic acidosis. The patient should avoid foods high in potassium. Other causes of acute glomerulonephritis have outcomes varying from complete recovery to complete renal failure. Prognosis depends on the underlying disease and the overall health of the patient.