Duration

The duration of the disease cannot be clearly determined. Rheumatic fever is on the one hand itself a secondary disease of a bacterial infection, but on the other hand it also involves some protracted secondary diseases. The previous streptococcal infection can last for about 1-3 weeks.

The subsequent symptom-free phase also lasts for about 2 weeks, whereas acute rheumatic fever lasts up to 12 weeks. Thus, the period from the infection until the fever symptoms subside lasts on average about 14 weeks. However, some secondary diseases can occur that have no limited duration.

If left untreated, the symptoms can exist for years. The duration of the drug treatment varies depending on the severity of the rheumatic fever. In most cases, the drugs must be taken over 5 years or until the age of 21, more rarely over 10 years, in order to prevent relapses and chronic progression.

History

The course of the disease can be divided into 4 stages:

Streptococcus infection
Latency (=period without symptoms) of 1-3 weeks
Rheumatic fever, duration approx. 6-12 weeks
Valve defects and scars from heart involvement

Rheumatic fever treatment

The drug of choice for streptococcal infections is the antibiotic penicillin because the bacterial species is sensitive to this drug, i.e. the bacteria die under therapy with penicillin. The first step in the therapy of rheumatic fever is the administration of penicillin for 10 days with the aim of killing still living streptococci. If there is an allergy to this antibiotic, macrolides such as erythromycin are prescribed.

An anti-inflammatory concomitant treatment with acetylsalicylic acid (e.g. Aspirin ®) or corticosteroids (e.g. cortisone) in the case of cardiac involvement is performed. Following this initial treatment, patients must take a lower dose of penicillin over a period of 10 years to prevent recurrence of rheumatic fever.

If the heart is affected by the inflammatory process, this period of administration may be extended. The antibiotic is usually administered at four-week intervals with an intramuscular injection (administration of the drug by injection into the muscle), so that the drug does not have to be taken daily in tablet form. After the end of many years of therapy, penicillins should be administered during diagnostic or surgical procedures (e.g. dental examinations, operations in hospital) to avoid inflammation of the inner layer of the heart (endocarditis prophylaxis).

This can occur if, for example, during dental treatment, bacteria from the mouth, nose and throat area, including streptococci, enter the bloodstream and cause an inflammatory reaction. The antibiotic protection before, during and after the examination or operation serves to prevent the recurrence of rheumatic fever with heart valve involvement or a worsening of the heart valve changes after rheumatic fever has taken place. Medical guidelines provide physicians with assistance in the treatment of certain clinical pictures.

They are not legally binding, but are systematic statements on the disease that have been summarized over years. They provide a decision-making aid for diagnosis, therapy and prevention, but must always be adapted to the individual case.The guidelines on rheumatic fever or post-streptococcal arthritis are published by various societies. The “Deutsche Gesellschaft für Rheumatologie e. V.” published a general recommendation for the treatment of rheumatic fever in children and adults.

The “Deutsche Gesellschaft für pädiatrische Kardiologie” on the other hand published a guideline explicitly for children and adolescents. The guidelines comprise eight subheadings, which summarize the complete management of the disease. First of all, rheumatic fever is defined biochemically and the classification of the disease stages is based on various criteria.

Then the symptoms and accompanying signs of the disease are described and the optimal diagnostic procedure is shown. Differential diagnoses for exclusion are also mentioned. The therapy is listed step by step in the fifth sub-item. The guideline concludes with recommendations for aftercare, prevention and prophylaxis of rheumatic fever.