"The hospital was filled with 90 children and adolescents today, and there was even a waiting list. Almost all of the patients had heart disease and were recovering from 6 months to 1 year after one or more attacks of acute rheumatic fever. We have nowhere else to put them." (Markowitz 3) Much has changed since five decades ago when a doctor wrote the above statement in his medical journal. Rheumatic fever, a complication of Group A streptococcal infections, is found in only a minute amount of children and adolescents today. It has taken over 50 years but we now know many things about this mysterious disease. We are now able to identify the signs and symptoms, potential causes, risk factors, and seemingly effective treatments, based on our short history while living with the disease.
Rheumatic fever is often easy to identify because of all of the symptoms which accompany it. Its prime targets are those who are between the ages of 4 and 18. The disease attacks connective tissues like those located in joints. People to be found with rheumatic fever can expect joint swelling in the wrists, elbows, knees, and ankles. The swelling should go away in about 2 weeks but if it isn't treated right away, other joints can be affected. If a parent suspects that their child has the disease, they should look for a fever, loss of appetite, general ill feeling, mild skin rash on the chest, fatigue, paleness, shortness of breath, swelling of the legs and back, and the most prevalent symptom, a rapid heartbeat, especially while lying down (Davis 56). Although most symptoms disappear within weeks to months, about half the time the disease leaves behind deformed heart valves. These valves won't work properly and will definitely cause limited activities, and maybe even premature death.
Scientists have spent a long time trying to pin down exactly what causes rheumatic fever. They have determined that rheumatic fever is caused "by a preceding strep infection, usually in the throat, that occurs 1 to 6 weeks prior to the onset of the child's symptoms." (Wilson 32) Even though this has been found to be true in 95% of all rheumatic fever cases, doctors can't explain the reason for one person getting it over another. They think that it is an autoimmune disorder, which means that when the body produces antibodies to fight the bacteria, they also attack tissues of joints or tissues in the heart. In other words, rheumatic fever is thought to be triggered by an overly active immune system (Blair 87).
Doctors and scientists have found a few recurring factors, which may increase a person's risks of getting the disease. Studies have been done over the past 30 years that indicate that genetics may play a part in susceptibility to the disease. Families that have a history of rheumatic fever are more at risk than those who do not. Also, poor nutrition has been linked to rheumatic fever. Poor nutrition was found in twice as many affected children, and therefore has been listed as a risk factor (Graham 142). Increased numbers of infections can be seen in crowded or unsanitary living conditions (Wilson 55). It was probably this fact which caused recent outbreaks of rheumatic fever in military bases in both Utah and Kansas. Of course, the most obvious way to obtain rheumatic fever is to leave streptococcal infections untreated (Davis 67).
Once contracted, not much can be done to combat rheumatic fever. Parents can regulate their child's temperature and pulse rate, in addition to using a humidifier. If the patient goes to see a doctor, the doctor may prescribe steroids to reduce the swelling in the joints, diuretics to reduce fluid retention, or antibiotics to fight any loitering strep bacteria (Blair 45). Even with taking these steps, the disease wreaks so much damage on the heart valves that they have to be surgically repaired or replaced with man-made or even animal implants. Patients usually require bed rest for 2 to 5 weeks, but some need months to recover (McGregor 65).
Many people who have had the disease experience little or no heart problems. However, a small percentage of patients experience the heart crippling part of the disease. The most destructive effect of rheumatic fever is carditis, "which develops in up to 50% of patients and may affect the endocardium, myocardium, pericardium, or the heart valves. Severe rheumatic carditis may cause congestive heart failure and significant mitral valve and aortic murmurs." (Blair 94)
Rheumatic fever will pop up again whenever its victims experience any new strep infections. The American Heart Association recommends that anyone who has experienced rheumatic fever take prophylactic, or preventive, doses of antibiotics (Thomason 76). The amount of time a person should take these is different for each individual patient. Most children take drugs into adulthood to combat any further strep infections.
Rheumatic fever has taken its toll on America throughout the years. All in all, rheumatic fever has affected over 1.8 million Americans (Wilson 65). It was at its peak about 40 years ago, and the American people feared there was another epidemic on the horizon. It may be close to gone, but it is not forgotten. 15,000 children and adolescents died in 1950 alone. Even though it has been cut down significantly, rheumatic fever continues to kill about 5,000 people each year (Markowitz 5). Modern medicine would like to be responsible for the sharp decline around 1970, but the disappearance of rheumatic fever is partly due to changes in the host (us), improved living conditions, and changes in the pathogenic potential of streptococci (Graham 87). Was there any way to stop it? Now doctors look at their treatments in the 1950s as trivial. If the bacteria hadn't changed, would we have had another epidemic on our hands?
What can we look forward to in the future? There are some obvious limitations on where we can go with antibiotics. With antibiotics we can never expect to eradicate rheumatic fever. To get rid of it forever, we can only hope for a vaccine (Davis 139). Without the vaccine, the bacteria might change again, and give us an unexpected glimpse back to the horrors of the 1950s. Some advances have been made to produce the vaccine, but have been put on the "back-burner" due to the low mortality rate.
Rheumatic fever has affected over half a million people around the world and their families. Although we can't seem to stop it, we can comfort those who suffer from it. Perhaps one day we may see a vaccine and an end to rheumatic fever. Until then, we can study and learn about the symptoms, causes, risk factors, and treatments, in the hopes that we can rid the world of another disease.