Concern over reheumatic fever and reheumatic heart disease suggests early treatment for a srep throat could prevent it becoming more serious
This letter is prompted by my recent letters regarding the welfare and medical needs of a young Solomon Islander girl of 16 years who is requiring to go to Australia to receive heart surgery following contracting rheumatic fever and, reportedly, heart valve complications arising from the fever.
I was keen to know the nature of the illness and how prevalent it is in the Solomon Islands.
From what I managed to find online, I can say this.
As a developing nation is claimed the burden of rheumatic heart disease remains “poorly understood,” in the Solomon Islands
I do not yet know the ratio of rheumatic heart disease cases in the Solomon Islands in relation to the types of other serious illnesses I wrote about yesterday, but it is my hope that the disease is not “poorly understood,” as claimed in one online piece I read.
If early treatment for a streptococcal sore throat can possibly prevent the development of rheumatic fever with penicillin treatment , is penicillin readily available in the Solomon Islands and what public knowledge is available to the community at large, especially parents, about the need to treat a child with symptoms of a sore throat that could lead to streptococcal infection?
I say this because Rheumatic feverusually follows an untreated beta-haemolytic streptococcal throat infection in children. It can affect many parts of the body, and may result in rheumatic heart disease, in which the heart valves are permanently damaged, and which may progress to heart failure, atrial fibrillation, and embolic stroke.
Nowadays, rheumatic fever mostly affects children in developing countries, especially where poverty is widespread. Up to 1% of all schoolchildren in Africa, Asia, the Eastern Mediterranean region and Latin America show signs of the disease. Of 12 million people currently affected by rheumatic fever and rheumatic heart disease, two thirds are children between 5 and 15 years of age. There are around 300 000 deaths each year, with two million people requiring repeated hospitalization and one million likely to require surgery in the next 5 to 20 years.
Early treatment of streptococcal sore throat can preclude the development of rheumatic fever. Regular long term penicillin treatment can prevent rheumatic fever becoming rheumatic heart disease, and can halt disease progression in people whose heart valves are already damaged by the disease.
In many developing countries, lack of awareness of these measures, coupled with shortages of money and resources, are important barriers to the control of the disease.
Rheumatic fever is an inflammatory disorder caused by a group A strep throat infection. It affects the connective tissue of the body, causing temporary, painful arthritis and other symptoms.
In some cases rheumatic fever causes long-term damage to the heart and its valves. This is called rheumatic heart disease.
Rheumatic fever occurs as a result of a rare strain of strep throat that isn’t treated with antibiotics quickly enough or at all. Doctors aren’t sure why this rare strain of strep triggers this inflammatory disorder. It’s probably because antibodies (special proteins in the blood that attack strep) mistakenly also attack healthy cells, such as the heart muscle and valve cells, as well as joint, brain and skin tissue, causing a reaction that results in inflammation.
Strep throat is most common in school-aged children, and so is rheumatic fever. Rheumatic fever was a leading cause of disability and death in children in the United States before 1960. Today, rheumatic fever is not common in the United States because most people have access to penicillin and other antibiotics. However, it does still occur in the US and remains a leading cause of early death in countries with less-developed healthcare systems.
Rheumatic fever can cause inflammation of the heart muscle and heart tissue. Carditis can cause a rapid heart rate, fatigue, shortness of breath and exercise intolerance. This is the most serious of the symptoms and may have long-term effects on health. Carditis occurs in approximately 50 percent of those who have rheumatic fever.
Arthritis: swelling, redness and pain in the joints, especially knees, ankles, elbows and wrists. These are common symptom and occurs in approximately 70 percent of people who have rheumatic fever
There is no single test to diagnose rheumatic fever. A child's doctor may use the modified Jones criteria to determine if the child has rheumatic fever. A child must show evidence of a prior strep infection through throat culture or blood work, as well as labs that show inflammation in the body. These tests, combined with other physical findings and signs of heart involvement, help doctors make the diagnosis.
Penicillin, aspirin and other medicines are used to treat rheumatic fever. Children will also have to stay on a low dose of penicillin for years to reduce the risk of recurrence. It's very important to prevent a recurrence because of the risk of more damage to the heart.
Carditis, or inflammation of the heart muscle and tissue, is the most serious result of rheumatic fever. Some children don’t develop carditis while others develop mild carditis that may not cause problems in the future.
For children who do develop severe carditis, the inflammation leads to scarring and permanent damage to the heart, and particularly to the heart valves. The mitral valve, which controls the flow of blood between the upper left chamber and the lower left chamber of the heart, is most often damaged. The aortic valve, which sends the blood from the left lower chamber out to the body, is the next most commonly affected heart valve. Leakage of the heart valves is the most common finding.
Children and teens that have serious rheumatic heart disease will need to see a cardiologist regularly for the rest of their lives.
Comment
The contents of this letter should not preclude proper medical advice from a qualified medical doctor on the disease I have referred to.
The basis of the research is from online data where no official sources were quoted.
My aim in writing the piece was to have a better understanding of the medical condition the 16 yr old teenager is said to have and hope it might induce help for her, but also my hope that the MHMS is able to give appropriate medical treatment with penicillin when a child is examined and found to be suffering from an early strep throat infection, after all prevention is better than a cure.
