Rheumatic fever

  • Streptococcal allergic secondary disease
  • Streptococcus associated arthritis
  • Streptococcus associated endocarditis

Definition

Rheumatic fever is an inflammatory reaction of the body. Toxins (bacterial toxins), which are produced by bacteria from the group of streptococci, cause this secondary illness to occur after a bacterial infection of the upper airways. Patients typically had streptococcal angina tonsillaris (tonsillitis) or pharyngitis (inflammation of the throat) 10-20 days before the onset of rheumatic fever.

Causes

During this symptom-free interval of about 10-20 days, during which the patient does not feel ill, the body develops antibodies (the body’s own antibodies) against the bacteria that previously caused the inflammation of the upper airways: The immune system forms antibodies against the invading bacteria. The body’s own structures such as joints, heart muscle, skin or brain cells have proteins similar to the bacterial protein, so that a cross-reaction takes place between the body cells and the antibodies formed. This means that the antibodies originally formed as an immune response against the bacteria are now directed against the body’s own joint components or heart muscle cells, among others. This results in arthritis (joint inflammation) or endocarditis in patients suffering from rheumatic fever.

Frequency and occurrence

The peak incidence of the disease is between the ages of 5 and 15. Rheumatic fever is now rare in industrialized countries because treatment of tonsillitis (angina tonsillaris) with penicillin prevents the second disease.

Symptoms

After a period of 10-20 days after a streptococcal angina tonsillaris or streptococcal pharyngitis, in which the patient has no symptoms, various symptoms occur. These affect the joints, skin, heart and central nervous system:

  • The patient has a fever, headache and sweating increased. These are unspecific symptoms, but very typical in the presence of rheumatic fever.
  • These are unspecific symptoms, but very typical in the presence of rheumatic fever.
  • Several large joints such as the hip joints, ankle or knee joints hurt, are overheated and swell (joint inflammation, arthritis).

    The involvement of the joints is known as acute wandering polyarthritis, because the symptoms occur one after the other and at several joints, i.e. “jumping” from one joint to the other.

  • Skin changes occur in the context of rheumatic fever. The so-called rheumatic nodules are nodular changes in the subcutaneous tissue, which are preferably located on the extensor sides of the arms and legs, but can also occur on the heart valves. In addition, 10% of patients have circumscribed reddened skin areas (erythema anulare), which are mainly located on the trunk of the body.
  • The so-called rheumatic nodules are nodular changes in the subcutaneous tissue, which are preferably located on the extensor sides of the arms and legs, but can also occur on the heart valves.
  • In addition, 10% of the patients have circumscribed reddened skin areas (erythema anulare), which are mainly located on the trunk of the body.
  • The so-called erythema nodosum occurs as raised, pressure-painful knot formation on the lower leg.
  • Rheumatic fever also affects the heart: all parts of the heart wall can be affected by the inflammatory reaction, with a distinction being made between inflammation of the heart muscle (myocarditis), the inner layer of the heart (endocarditis) and inflammation of the pericardium (pericarditis).
  • All components of the heart wall can be affected by the inflammatory reaction, whereby a distinction is made between inflammation of the heart muscle (myocarditis), the inner layer of the heart (endocarditis) and inflammation of the pericardium (pericarditis).
  • Myocarditis is associated with an increased heart rate (tachycardia) and a non-rhythmic heartbeat (arrhythmia).
  • Inflammation of the inner layer of the heart (endocarditis) is a major factor in the prognosis of the disease, as the heart valves are formed by the inner layer of the heart (endocardium).

    As part of the body’s immune response, wart-like deposits are formed on the edge of the heart valves, which change the valves in their form and function.However, intact heart valves are of crucial importance for the normal pumping function of the heart: the heart valves altered by rheumatic fever lead to a restricted pumping function of the heart.

  • At the edge of the heart valves, wart-like deposits are formed as part of the body’s immune reaction, which change the valves in their form and function. However, intact heart valves are crucial for the normal pumping function of the heart:
  • The heart valves altered by rheumatic fever lead to a limited pumping function of the heart.
  • Symptoms caused by inflammatory changes in the central nervous system may occur even after a symptom-free interval of months, but they are rare overall. Patients notice uncontrolled hand movements, clumsiness or their own involuntary grimacing of the face.

    These symptoms are collectively known as minor chorea; they are an expression of an inflammation of the brain (encephalitis).

  • If the symptom complex of minor chorea occurs, an examination for an inflammatory process of the heart should also be performed.
  • These are unspecific symptoms, but very typical in the presence of rheumatic fever.
  • The so-called rheumatic nodules are nodular changes in the subcutaneous tissue, which are preferably located on the extensor sides of the arms and legs, but can also occur on the heart valves.
  • In addition, 10% of the patients have circumscribed reddened skin areas (erythema anulare), which are mainly located on the trunk of the body.
  • All components of the heart wall can be affected by the inflammatory reaction, whereby a distinction is made between inflammation of the heart muscle (myocarditis), the inner layer of the heart (endocarditis) and inflammation of the pericardium (pericarditis).
  • At the edge of the heart valves, wart-like deposits are formed as part of the body’s immune reaction, which change the valves in their form and function. However, intact heart valves are crucial for the normal pumping function of the heart:
  • The heart valves altered by rheumatic fever lead to a limited pumping function of the heart.

A rheumatic fever can also occur without an elevated temperature of the affected person. According to the underlying classification criteria (Jones criteria), rheumatic fever can be diagnosed even without the presence of fever.

High fever occurs more frequently in children and adolescents. It can be a sign of a persistent bacterial infection (often with streptococci) in the upper respiratory tract, which is often the cause of rheumatic fever. In addition, the fever can indicate a severe inflammation in the human body.