Rheumatic fever natural history, complications, and prognosis
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Lance Christiansen, D.O.; Associate Editor(s)-in-Chief: Cafer Zorkun, M.D., Ph.D. [2]; Varun Kumar, M.B.B.S. [3]; Anthony Gallo, B.S. [4]
Overview
If left untreated, [#]% of patients with [disease name] may progress to develop [manifestation 1], [manifestation 2], and [manifestation 3]. Common complications of [disease name] include [complication 1], [complication 2], and [complication 3]. Prognosis is generally excellent/good/poor, and the 1/5/10-year mortality/survival rate of patients with [disease name] is approximately [#]%
Natural History
If an individual develops rheumatic fever, they will experience the development of increased sensitization to Streptococcus pyogenes autoantigens. An infection by a virulent strain of Streptococcus pyogenes, at a later date, will likely cause an elevated, autoimmunological response and a recurrent case, probably a more severe case, of rheumatic fever will develop.
If an individual does not contract a Streptococcus pyogenes infection for five years or longer, his/her immunological/autoimmunological responsivness will naturally decrease and, therefore they are less likely to develop rheumatic fever if the individual contracts Streptococcal infection in the future.
The above natural phenomenon is the basis for the use of prophylactic penicillin therapy among individuals who are at risk for rheumatic fever. Providing individuals who have had rheumatic fever with Benzathine Penicillin G, 1,200,000 units every three weeks, or oral penicillin VK or G, 250mg twice daily, decreases the frequency of recurrent streptococcal infection and subsequent recurrent rheumatic fever. It is estimated that the recurrence rate of rheumatic fever is decreased by about 85% by providing prophylactic penicillin therapy. Recurrence rate of 0.2/patient/year follow-up was noted among those not receiving regular secondary prophylaxis in a series involving 120 children with initial rheumatic fever being followed-up for 6 years. While the recurrence rate among those receiving regular secondary prophylaxis was reported to be 0.005/patient/year follow-up[1].
Rheumatic fever if left untreated, may cause valvular diseases such as stenosis/regurgitation of mitral/aortic valves and myocarditis. This may lead to decreased cardiac output, pulmonary edema and ultimately cardiac failure. In a series where 497 children on treatment for rheumatic fever were followed over 10years, 19 children were reported to have died of rheumatic fever and rheumatic heart disease. Prognosis among those with pre-existing heart disease was poor[2].
Cardiac arrhythmias, systemic emboli and infective endocarditis are other possible complications of rheumatic carditis.
Complications
Complications to rheumatic fever include:[1][3][4]
- Mitral stenosis
- Aortic stenosis
- Endocarditis
- Infective endocarditis
- Cardiac failure
- Arrhythmias
- Systemic emboli leading to stroke
- Pericarditis
- Sydenham chorea
- Recurrence of rheumatic fever
Prognosis
For cases intentionally without carditis, the prognosis is excellent, demonstrating no residual heart disease. In cases with preexisting heart disease, the prognosis was poor, leading to mortality.[5]
References
- ↑ 1.0 1.1 Majeed HA, Yousof AM, Khuffash FA, Yusuf AR, Farwana S, Khan N (1986). "The natural history of acute rheumatic fever in Kuwait: a prospective six year follow-up report". J Chronic Dis. 39 (5): 361–9. PMID 3700577.
- ↑ "The natural history of rheumatic fever and rheumatic heart disease. Ten-year report of a cooperative clinical trial of ACTH, cortisone, and aspirin". Circulation. 32 (3): 457–76. 1965. PMID 4284068.
- ↑ Garg N, Kandpal B, Garg N, Tewari S, Kapoor A, Goel P; et al. (2005). "Characteristics of infective endocarditis in a developing country-clinical profile and outcome in 192 Indian patients, 1992-2001". Int J Cardiol. 98 (2): 253–60. doi:10.1016/j.ijcard.2003.10.043. PMID 15686775.
- ↑ Carapetis JR, Steer AC, Mulholland EK, Weber M (2005). "The global burden of group A streptococcal diseases". Lancet Infect Dis. 5 (11): 685–94. doi:10.1016/S1473-3099(05)70267-X. PMID 16253886.
- ↑ The Natural History of Rheumatic Fever and Rheumatic Heart Disease, Rheumatic Fever Working Party of the Medical Research Council of Great Britain and the American Heart Association (1965). http://circ.ahajournals.org/content/32/3/457 Accessed on October 12, 2015