ABSTRACT
Rheumatic fever is an auto-immune disease caused by
exposure to Streptococcus pyogenes. Over the last 50 years, reports of
rheumatic fever within the United States have diminished. The decrease was
attributed to the advent of penicillin in the treatment of streptococcus
infections. We propose that current diagnostic and treatment methodologies may
adversely increase the morbidity rate of rheumatic fever within the United
States. Publication rates and interest in rheumatic fever has diminished over the last 30 years. Because of this decline, many physicians are only vaguely aware
of the disorder. Additionally, the fear of antibiotic resistance has influenced
theCenterofDisease Control to suggest a
significant decrease in the use of antibiotics by physicians. Although extremely
valid for the future health and well-being of the population, such policies
must be examined for each individual case carefully. The American Heart
Association prescribes long-term antibiotic prophylaxis as the only current
treatment; however literature reviews indicate that such therapy is rarely
used. Therefore individuals diagnosed with rheumatic fever are not being
treated. Additionally, because many physicians are not routinely testing for
streptococcus or early signs of endocarditis, it is likely that cases of
rheumatic fever will increase in the future, and many individuals may not be
diagnosed until sever damage or morbidity occurs. Physician education and
clear revised guidelines are necessary to ensure adequate treatment of
individuals with rheumatic fever. Mis-understandings of the disease and how
it should be treated by first responders (i.e. primary care providers and pediatricians) are discussed.
References
[1] Guilherme, L. and Kalil, J. (2004) Rheumatic fever: From sore throat to autoimmune heart lesions. International Ar chives of Allergy and Immunology, 134, 56-64.
doi:10.1159/000077915
[2] Akikusa, J.D. (2012) Rheumatologic emergencies in newborns, children, and adolescents. The Pediatric Clinics of North America, 59, 285-299.
[3] Inoff-Germain, G., Rodrigues, R.S., Torres-Alcantara, S., Diaz-Jimenez, M., Swedo, S.E. and Rapoport, J.L. (2003) An immunological marker (D8/17) associated with rheumatic fever as a predictor of childhood psychiatric disorders in a community sample. Journal of Child Psychology and Psychiatry, 44, 782-790.
doi:10.1111/1469-7610.00163
[4] Azevedo, P.M., Pereira, R.R. and Guilherme, L. (2012) Understanding rheumatic fever. Rheumatology International, 32, 1113-1120. doi:10.1007/s00296-011-2152-z
[5] Galvin, J.E., Hemric, M.E., Ward, K. and Cunningham, M.W. (2000) Cytotoxic mAb from rheumatic carditis re cognizes heart valves and laminin. The Journal of Clinical Investigation, 106, 217-224. doi:10.1172/JCI7132
[6] Roberts, S., Kosanke, S., Terrence Dunn, S., Jankelow, D., Duran, C.M. and Cunningham, M.W. (2001) Pathogenic mechanisms in rheumatic carditis: Focus on valvular endothelium. The Journal of Infectious Diseases, 183, 507-511. doi:10.1086/318076
[7] Spagnuolo, M. and Taranta, A. (1968) Rheumatic fever in siblings. Similarity of its clinical manifestations. The New England Journal of Medicine, 278, 183-188.
doi:10.1056/NEJM196801252780403
[8] Guilherme, L., Ramasawmy, R. and Kalil, J. (2007) Rheumatic fever and rheumatic heart disease: Genetics and pathogenesis. Scandinavian Journal of Immunology, 66, 199-207. doi:10.1111/j.1365-3083.2007.01974.x
[9] Center for Disease Control. (1987) Acute rheumatic fever—Utah. Morbidity and Mortality Weekly Report, 36, 108-110.
www.cdc.gov/mmwr/preview/mmwrhtml/00000880.htm
[10] Center for Disease Control. (2012) Is it strep throat?
http://www.cdc.gov/Features/StrepThroat/
[11] Baltimore, R.S. (2010) Re-evaluation of antibiotic treatment of streptococcal pharyngitis. Current Opinion in Pediatrics, 22, 7-82. doi:10.1097/MOP.0b013e32833502e7
[12] Center of Disease Control. (2012) Careful antibiotic use.
www.cdc.gov/getsmart/campaign-materials/info-sheets/child-practice-tips.pdf
[13] Gerber, M.A., Baltimore, R.S., Eaton, C.B., Gewitz, M., Rowley, A.H., Shulman, S.T. and Taubert, K.A. (2009) Prevention of rheumatic fever and diagnosis and treatment of acute streptococcal pharyngitis. Circulation, 119, 1541-1551. doi:10.1161/CIRCULATIONAHA.109.191959