Rheumatic fever hard to diagnose, even with test

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.