Does your child often get a sore throat or tonsillitis? Sometimes we think it's just a common cold and don't pay much attention to it. But if after a few days your child starts saying things like "Mommy, my knee hurts," or "My leg feels numb," don't just dismiss it. Because, it could be the beginning of a condition called rheumatic fever that we're talking about today. This is something to be careful about, so let's talk about it in more detail.
Simply put, what is rheumatic fever?
Rheumatic fever is a rare autoimmune disease that causes the body's tissues and organs to swell. In simple terms, this is how it works. Think of our immune system as an army protecting a country. The job of this army is to identify and attack foreign invaders (viruses, bacteria) and protect us from disease.
Now, let's say your child has strep throat or scarlet fever. Both of these infections are caused by a type of bacteria called Group A Streptococcus. If we don't treat the infection properly with antibiotics, our body's army gets a little nervous. While they're fighting off the bacteria, they make a little mistake. They see our own healthy tissue and think, "Oh, here's an enemy," and they start attacking it too. It's like our own army bombing our own cities.
This immune system's misdirected response causes inflammation in the child's joints, heart, blood vessels, skin, and brain . This condition is called rheumatic fever.
The important thing is that rheumatic fever is not a throat infection. It is a very rare but serious complication of an untreated throat infection.
What are the symptoms of rheumatic fever in a child?
The symptoms of rheumatic fever can vary from one child to another. Sometimes a child's throat infection is so mild that you may not even notice it. The symptoms of rheumatic fever usually appear two to three weeks later. These symptoms can be similar to other common illnesses, so we can sometimes be misled. But it's important to be aware of this.
Let's see what the main symptoms are in the table below.
| Symptom | Description and things to watch out for |
|---|---|
| Joint swelling and pain (Arthritis) | This is the most common symptom. The child's large joints, such as the knees, ankles, elbows, and wrists, become red, swollen, and painful. The pain often 'jumps' from one joint to another. If the knee hurts today, the ankle may hurt tomorrow. |
| Carditis | This is the most serious symptom of rheumatic fever. It can cause chest pain, shortness of breath, and a feeling that the heart is beating fast. Sometimes, when the doctor puts a stethoscope to the child's chest, he or she may hear an unusual sound (murmur). |
| Uncontrolled movements (Chorea) | This is a strange symptom. The child's arms, legs, and facial muscles twitch uncontrollably, as if they are dancing. The child is unable to do things like write, eat, or button their clothes. This is caused by damage to the brain. |
| Lumps under the skin (Nodules) | Small, painless lumps that look like bones may appear under the skin near joints such as the child's elbows, knees, and wrists. These usually go away in a few weeks. |
| Red skin rash | Some children develop red, round, well-defined bumps on their bodies, especially on their chest, stomach, and back. These usually don't itch. |
| Other common features | In addition to these main symptoms, you may also experience fever, extreme fatigue, body aches, headaches, and swollen, red tonsils . |
Who is most at risk of developing this disease?
Although anyone can develop rheumatic fever, some people are at higher risk.
- Age: This disease mostly affects children and young adults between the ages of 5 and 15. It is very rare for people under the age of 5 and over the age of 15 to develop it.
- Living environment: The risk is higher in places where many people gather together (for example, schools, daycare centers, crowded homes) because bacteria spread easily.
- Family history: If someone in the family has had rheumatic fever, others may have a tendency to develop it too.
- Frequent throat infections: If a child has frequent strep throat infections, the risk of developing rheumatic fever increases.
- Health facilities: Children living in remote areas where medical facilities are difficult to access are at higher risk as they may not receive timely treatment for a throat infection.
Is it true that rheumatic fever affects the heart?
Yes, this is the most scary and concerning thing when we talk about rheumatic fever. Rheumatic fever doesn't always affect the heart. But when it does, it can damage the heart tissue, especially the heart valves .
Think of heart valves as doors in our hearts. Their job is to allow blood to flow in only one direction and prevent it from flowing back. Rheumatic fever can cause scar tissue to form on these valves, causing them to not close properly or to not open properly. This can interfere with the functioning of the heart.
We call this condition Rheumatic Heart Disease . The most dangerous thing is that the symptoms of this heart disease can sometimes appear 10-20 years after the onset of rheumatic fever.
That's why long-term medical monitoring is so important for a child who has rheumatic fever. This allows early detection of heart damage and treatment.
How does a doctor diagnose this disease?
If your child has a sore throat for more than two or three days, be sure to see a doctor. Treating a strep infection is the best way to prevent rheumatic fever.
If the doctor examines your child and suspects rheumatic fever, they will perform several tests, such as:
1. Throat Swab: A small sample of the throat is taken to check for the presence of the `Group A Streptococcus` bacteria. This can be done as a `Rapid Strep Test` which gives results in 10 minutes, or it can be sent for a `Throat Culture` which takes several days to test.
2. Blood Tests: The child's blood can be checked for antibodies against the Strep bacteria. They can also check levels of things like CRP and ESR, which indicate inflammation in the body.
3. Heart Tests: These tests are very important to determine if the heart has been affected.
- EKG (Electrocardiogram): A test that looks at the electrical activity of the heart.
- Echocardiogram (Echo): Like a scan, this can clearly see how the heart's valves and muscles are working.
Jones Criteria
Doctors use a special set of guidelines called the "Jones criteria" to diagnose rheumatic fever. This is like a scoring system. To confirm the disease, the child must have at least two of the major criteria below, or one major criterion and two minor criteria, along with evidence of a previous strep infection.
| Major Criteria | Minor Criteria |
|---|---|
| Inflammation of several joints (Arthritis) | Fever |
| Carditis | Elevated ESR or CRP levels in the blood |
| Lumps under the skin (Nodules) | Joint pain (Arthralgia) |
| Uncontrolled movements (Chorea) | Changes in EKG test |
| Erythema marginatum (skin rash) | Having had rheumatic fever or rheumatic heart disease before |
What are the treatments for rheumatic fever?
There are several main goals when treating rheumatic fever.
1. Eradicating the bacterial infection: The first step is to completely eliminate the Strep bacteria that causes rheumatic fever from the body. For this, the doctor will prescribe antibiotics . This may be a one-time injection or a 10-day course of antibiotics. The most important thing is to take the full course of medication, even if the child feels better. Otherwise, the infection may come back.
2. Controlling swelling: Anti-inflammatory medications are given to reduce swelling and pain in the body. These are very helpful for joint pain. If the symptoms are severe, especially if the heart is affected, stronger medications like `Corticosteroids` may also be given.
3. Preventing recurrence: This is very important. If a child has had rheumatic fever once, they are more likely to get rheumatic fever again if they get a strep infection again. To prevent this, the doctor may put the child on a long-term course of antibiotics . This may be a monthly penicillin injection. This treatment may need to be continued for years, sometimes until the child is an adult.
How do we protect our children from this disease?
The best and only way to prevent rheumatic fever is to diagnose and treat strep throat and scarlet fever promptly and correctly.
- Don't ignore a sore throat: If a child has a sore throat for more than three days, has difficulty swallowing, has swollen lymph nodes in the neck, or has a fever, be sure to see a doctor.
- Give antibiotics exactly as prescribed: Give the medicine as prescribed by the doctor for the full duration. Don't stop taking it halfway, saying your child will be better in two days.
- Good hygiene habits:
- Teach your child to wash their hands thoroughly with soap regularly.
- Teach them to cover their mouth and nose with a tissue or their elbow when coughing or sneezing.
- Make sure that other people do not use your child's plates, cups, and spoons.
By taking care of these things, you can do a great deal to protect your child from a serious condition like rheumatic fever.
Take-Home Message
- If your child's sore throat lasts more than two or three days, is accompanied by symptoms such as fever, loss of appetite, or a lump in the neck, be sure to see a doctor.
- Rheumatic fever occurs as a result of an untreated Strep bacterial infection.
- This disease can cause long-term damage to a child's heart, joints, and nervous system, so early diagnosis and treatment are very important.
- Give your child the antibiotics prescribed by the doctor for the full duration. Do not stop taking them even if the symptoms subside.
- A child who has had rheumatic fever may need to take antibiotics for a long time to prevent it from coming back. Follow your doctor's instructions carefully.
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