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Recurrent Rheumatic Fever
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Recurrent Rheumatic Fever

I have moderate aortic valve disease. Latest echo shows Peak aortic gradient was in the region of 24mm/Hg.  Left ventricular cavity normal in size, left ventricular wall thickness normal at 0.9cm.  Left ventricular contractility -hyperdynamic with ejection fraction in the region of 55% Left atrium was normal-32mm.

I had also had a recent holter monitor which showed Predominant sinus rhythm, occasional ectopic beats, no complex ventricular arrhythmias.  Occasional superventricular ectopic beats. 3runs of atrial tachycardia possibly atrial fibrillation.

I have suffered pressure in my chest, severe very frequent palpitations (when usually it was a mild flutter very infrequently) and twisting
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Hi Karonnie,

Intersting question.  The text books talk about recurrent rheumatic fever and antibic phrophylaxis, but I have never seen a case of recurrent RF.  It is true that people who have had it are at risk for recurrence and should take antibiotics.

An acutely elevated ASO titre would suggest a recurrence.  If you have a significant sore throat, you should take antibiotics prophalaxis anyway.

There are some rheumatoligic conditions that cause similar symptoms (minus the chorea).  I would think a rheum problem is more likely than recurrent rheumatic fever, but it is still worth investigating and continuing standard antibiotic prophylaxis.

I hope this helps.  Thanks for posting.
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Avatar_n_tn
Hi,

Just wanted to offer you some reassurance. As a child I had scarletina-which I was told was a milder form of scarlet fever. I also was ever famous for a period of a few years of getting strep throat especially when I was about 11-13years old. I was good until about age 23 had 1 bout again and since then(knock on wood) I have had no other bout with strep. My tonsils are still intact and my heart is fine and I am a mom of 3 now.

I'm sure as she gets older she will build up more resistance to these strep infections.
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Avatar_n_tn

Hi there. I'm sorry yr little one has been sick and I can totally relate to your fear. I now gargle Hydrogen Peroxide 4 times a day and use it on a cotton bud in my ears most days, I am so scared about getting another bout while i'm in such a fragile state! You should see how I am with my son!!

I can't really tell you about when I was a child as I can't remember really what happened before I actually had my first attack of RFever diagnosed.

I have been going through my medical history trying to see exactly how many bouts I have had over the past 11 years, they are around 18m-2 years apart, some only 12m between strep throat infection - barely enough time to get over the last bout of RF and onto the next! I'm not sure what the usual is for an ordinary person, however I will say that my immune system is now severly depleted because i've been sick so many times without antibiotics and I pick up every virus that comes within 2 feet of me. I do know that you're more susceptible if you're around children, and of course health workers so this will be an issue for child care, school etc.

All I can say is beg, plead do anything to get antibiotics (although I must say my docs are crazy but it didn't help me - I am still in disbelief with my past history!!) if you suspect Strep with your child's history - this is a dangerous disease - it looks like I will be requiring a replacement valve very soon because of this! Ask for an ASO test to be done (not just a swab) - if it's negative then fine you can stop the treatment but I no longer trust that doctors can differentiate upon viewing me and my relaying my symptoms between an infection and a virus.  It's funny - I know the difference - I feel so different, ie myalgia, really really really sore throat so that I can't swallow, then it often feels like it moves further down the throat, usually no nasal congestion , really high fevers that take ages to come down with paracetamol or asprin, often I get night sweats.  But don't take my symptoms for it, every person is different and some people walk around without even knowing they have had one apparently, so maybe keep an eye on eating habit etc.  

It's funny - we do things to help us but I know things I did to help me symptomatically has probably masked my clinical presentation - such as anti inflammatories for my pain, throat lozenges (with anti inflammatory etc) making my throat not look so red and helping with temp, taking asprin for fever so when you present your clinical picture probably looks less severe - also delaying a visit because you're not feeling well (me i'm a single mother and live 20mins from my doc so often would delay driving because I felt so bad, mainly because I knew i'd be a waste of time - they just seemed to be crazy set on not giving out antibiotics. Still shaking my head!!)  The last time I was given penicillin BEFORE this - for a sore throat was 7 years ago!!  The years before, till I was 23, I was given them every time I had a sore throat - i'd even go on a Sat night to the all hours doc(for a good time - Not) to get them the minute I had a tickle in my throat.

I wished i'd known much more about my disease, and not been so trusting of my treating doctors, I asked my GP & 2 specialists and they all said no way you don't have it, but not 1 single one of them gave me a simple ASO test to prove it!! A hundred other tests that must have cost a fortune but not it! If I knew more about it I would have known before this, and fought like I have been to see someone who is knowledable - it's so different talking to people who deal with the disease, especially the chorea which i'd put down to so many other things - they make me feel sane and it's comforting.

I suggest you read as much as you can about them, forearmed is forewarned!  And if you feel something isn't right don't let them discount you until all tests can prove you wrong - that instinct is there for a reason!







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Avatar_n_tn
While I wouldn't dare to comment on your particular situation, there are very valid reasons not to treat in the absence of diagnostic confirmation of a bacterial infection such as strep.

My own personal situation was similar in regards to frequent strep throats (diagnosically proven) probably 3-4 times a year.  I was always given penicillin.  
Over the years, my doc became more casual about testing, and sometimes would call me in pcn just based on my description or appearance of my throat.
Then I took it one time, and had an anaphylacic reaction within 5 minutes of taking a dose of pcn.  After years of taking it without problems.  

You can indeed sensitize yourself to pcn after taking it frequently.  I am now also allergic to cephalosporins as well as pcn.  So I am limited now in good choices for future infections.  That is one reason docs are reluctant to treat in the absence of diagnostic proof--frequent exposure to antibiotics may sensitize you if you take them often enough.

(I have never had another strep throat after having my tonsils out as an adult.  It's been 15-20 years since my last strep.)
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Avatar_n_tn
My siblings had their tonsils out when they were 3 and 4.  I did not have mine taken out.  I had three bouts of tonsillitis a year. (Mother called them Strept)  She would walk miles to the pharmacy and get the penicillan and the syringes and I would have 3 shots (spaced every other day) Usually by the third day, I was feeling better and the fever was down. This went on until I was 18 and finally they took the tonsils out....all strept stopped and now I am "over the hill" and never had another one.  I keep wondering if I did not develop RF in those days. Cold, damp climate which brought on the heart problems, I have today.  We were too poor to see a doctor.

My son was never allergic to penicillan (pill form) until they gave him an injection of penicillan at age 17.  He broke out in a horrid rash.  Doctor said something about the Injection vs the pill form did this to him.
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Yes i'm with you definately on the recurrance of strep infections and seeking alternative methods, sometimes you've got to wonder what they are thinking (honestly!!) although isn't always the case as this infection affects the pharynx as well and that's where the Rheumatic Fever usually stems from, not the tonsils.

But in relation to becoming sensitive - definately it's a different story when the reaction is life threatening anphalyxis (sorry spelling!!) but if the reaction is a rash (especially as is often not even really an itchy one) often it's  not the chemical of the penicillin but the additional chemicals which are added to the drug for administration that MAY be the cause.  You wouldn't believe what they can put into these things "safely".  I'm sure some of you have read what they used to put into our vaccinations as children?  Wow!!

Don't rule out this possiblilty until you've ruled this out, and maybe done another test in the safety of family or better still wait in the surgery for a while after your first dosage.  If not your brother may be limiting his drug protection unwarranted and penicillin is such a better drug choice for many of these infections and so reducing the possibility of recurrance or complications.

I know my mother got a rash from one amoyxcillin dose she received and it had nothing to do with the drug she needed but the colour and chemicals they used to capsulate it!  
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Avatar_n_tn

Just as an addition to my previous posts, I have just recently gained a copy of my 1994 echo which mentions a new tricuspid valve regurgitation - without evidence Pulmonary Hypertension.

This really makes me extra angry that My Doc has overlooked this new murmur - obviously caused by one of my recent episodes of Rheumatic Fever - this is unbelievable!

Please where possible get copies of all your reports for your own piece of mind and in case you change doctor's or in the case of my doctor's office (apparently) they have thrown away my older ones which legally they are not allowed to do when i've been a continual patient for the past 8 years.
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Avatar_n_tn
Absolutely....Everyone get copies of records.  My visit visit to an ER room for chest pain...EKG, I was told was normal.  (the idiot ER doctor)  He Sent me home.  One month later, I went back to get records for a new doctor and the EKG showed I had suffered a heart attack. AND, this is no fly by night hospital. They let me go that night having a heart attack and told me it was PLEURISY! Numbskull doctors!~!  I was told the poor ER doctor was working a 12 hour shift and was TIRED!!!
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Avatar_n_tn

Just an update - have seen numerous specialists - including an immunologist - who was the most helpful overall with knowledge of all of Rheumatic Fever's symptoms which was a refreashing change instead of everyone looking at each thing specific to their area seperately and calling it sometimething else (or was arthritis the answer to everything! Well I suppose it was a change from most that it's a virus!!) - also ignoring the fact that prior to the sore throat I had nothing wrong with me for 9 months. I think the cardiologist was the biggest joke - he initially told me the fusing of my valve leaflets between echos(in 2months) was age related! Geez my Mum is 63 overweight, unfit and diabetic and originally we had the same thickening and regurgitation level of our aortic valve - she had RF at 15, and now I look like the 63 year old compared to her damage. I definately have had recurrances - my GP omitted to mention that the ASO test I was given in December was hindered by the administration of the antibiotics I was given at the ER for a suspect (which was negative later) urinary tract infection due to my WBC being raised when I was admitted with chest pain, palpations & syncope etc, the week before. My ASO's have been up and down since then and so i'm still symptomatic but nowhere near like earlier on and it only lasts a few days (or hours / minutes with the joint pain) instead of weeks and at least i'm finally on preventative penicillin treatment so I will have a better chance of being spared a recurrance in the future. All I can say about this is - if in doubt about your diagnoses keep on keeping on until you are happy with what you have been told. Listen to your heart and believe in yourself - sometimes we might not know what's wrong but we know when things aren't quite right.
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