Rheumatic fever

Rheumatic fever is a multisystem inflammatory disease that occurs as a delayed sequel to group A streptococcal pharyngitis (or GABHS: Group A beta haemolytic streptococcus). It may involve connective tissues of the heart, joints, skin and vessels. Symptoms include angina, sore throat, high fever and inflammation of the joints. Doctors prescribe antibiotics to eliminate the infection, otherwise the rheumatic fever can cause severe damage to the heart, notably the valves.

The peak incidence of rheumatic fever and rheumatic heart disease is in children between 5 and 15 years of age, and is most prevalent in developing countries. In India alone, it is estimated that over six million children are afflicted. Carditis is the most serious manifestation of RF and occurs early (within 3 weeks of onset). It is seen in 50% of cases on clinical examination and in 70% of cases by echocardiography. Clinically, rheumatic carditis is almost always associated with a murmur of valvulitis, most commonly the apical systolic murmur of mitral regurgitation and/or the basal diastolic murmur of aortic regurgitation.

General medical treatment is only symptomatic or supportive and the dramatic advances in cardiac surgery have not greatly reduced morbidity and mortality. At best, only a small proportion of patients can have these expensive operations and few developing countries can afford to provide them.

The range of incidence between different countries is shown in the following examples (frequency per 100,000 inhabitants): Martinique 200; Guadeloupe 17; Egypt 10; Thailand 1.2-2.1; India 1.8-11; USA 0.23-1.88; Japan 0.23-1.88; Denmark 0.23-1.88; Great Britain 0.23-1.88; Australia 0.23-1.88; France 0.08-0.15.