Is it possible that something as minor as a throat infection can damage a child’s heart? The answer is yes, if the infection is caused by the streptococci virus and develops into rheumatic fever.

What is rheumatic fever?

Rheumatic fever causes about 233,000 deaths annually, mostly among children and young adults living in poor, low-income developing countries. It is not an infection but a complication of an untreated group A streptococcal virus (strep). This virus causes throat infection and is the major cause of rheumatic heart disease (RHD). RHD weakens the heart muscle and causes heart valve damage that can, in time, lead to congestive heart failure and death.

Who is at risk for rheumatic fever?

Mostly children aged 5 to 15 and some adults are at risk. People with a weakened immune system may be more at risk. There is also a hereditary risk factor as some people may carry a gene or genes that make them more likely to develop the condition. Those who have had a previous attack of rheumatic fever are at high risk for a recurrent attack … and more damage to the heart. Unfortunately, just under 0.3% of strep throat infections progress to rheumatic or scarlet fever.

What are the symptoms?

Symptoms of a strep throat infection are:

    • Fever of 38,3 degrees Celcius or more
    • White or yellow coating on the tonsils
    • Swollen lymph glands in the neck and elsewhere
    • A sore throat without cold symptoms
    • A red rash that starts on the head and neck and moves to the trunk and extremities
    • Difficulty swallowing
    • Thick or bloody discharge from the nose (more often in children under 3 years of age)
    • Strawberry tongue; a bright red tongue with bumps all over.

Rheumatic fever signs and symptoms usually start from one to six weeks after a child has had a strep throat infection. They may include:

    • Fever
    • Joint pain or swelling in the child’s wrists, elbows, knees or ankles and less often the shoulders, hips, hands and feet
    • Pain in one joint that migrates to another joint
    • Small, painless bumps (nodules) under the skin
    • A flat or raised red rash with a ragged edge on the child’s chest, back or stomach
    • Chest pain
    • Stomach pain or loss of apetite
    • Weakness, shortness of breath or feeling very tired
    • Heart murmur
    • Jerky, uncontrollable body movements (Sydenham chorea or St. Vitus’ dance) of the hands, feet and face
    • Outbursts of unusual behaviour, such as crying or inappropriate laughing, that accompanies Sydenham chorea.

Treatment and prevention

Parents are advised to take immediate steps and seek a doctor’s advice if their child presents with any of the abovementioned symptoms, especially if the child is very young.

Rheumatic fever and RHD can be prevented and controlled by treating strep throat infection with antibiotics before it turns into rheumatic fever and RHD. For those who have already had rheumatic fever, preventing recurrent attacks is of the utmost importance to minimise further damage to the heart. This boils down to regular doses of antibiotics continued for many years.

Heart surgery to repair or replace damaged heart valves may also become necessary. Remember that heart damage from rheumatic fever does not always show up immediately and may take years to surface, so keep a close watch on any child that has had rheumatic fever.

South African scenario

As elsewhere, rheumatic heart disease is the leading cause of acquired heart disease in children and young adults in South Africa. The Heart and Stroke Foundation South Africa has given its support to a detailed action plan by the World Heart Federation (WHF) to reduce the premature deaths of young people under the age of 25 by 25% by the year 2025.

 

Sources

New action plan against rheumatic heart disease. Retrieved from: http://www.heartfoundation.co.za/media-releases/new-action-plan-against-rheumatic-heart-disease
Rheumatic fever. Retrieved from: http://www.mayoclinic.org/diseases-conditions/rheumatic-fever/basics/definition/CON-20031399
Rheumatic fever. 2013 . Retrieved from: http://www.texasheartinstitute.org/HIC/Topics/cond/rheufev.cfm
Rheumatic heart disease facts. Retrieved from: http://www.world-heart-federation.org/press/fact-sheets/rheumatic-heart-disease/