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.
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