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Re: rheumatic fever

Posted By CCF CARDIO MD - CRC on March 17, 1999 at 09:45:02:

In Reply to: rheumatic fever posted by myers-cruz on March 16, 1999 at 14:32:17:

My daughter who is a competitive gymnast was diagnosed with "reactive arthritis due to
a strep infection."  Prior to this she had a dog bite and had been on antibiotics
amoxycillin and was near end of that treatment when she apparently contracted a strep
infection at school. The residual antibiotic apparently masked all the tests they gave
my daughter while in the hospital: a whole body nuclear scan, throat culture, etc so they
did not give her any antibiotics/tylenol despite her fever. Once the fever became low grade for
approximately half a day they released her. She had a relapse and what started as just
pain in the hips, now involved her lower back, right wrist, knees, etc. Before we could
get the appointment to the specialist her hands peeled (sloughed off). The specialist gave
tolectin and overnight her pain was gone and she was fine.  The doctor mentioned how the
peeling hands were reminiscent of rheumatic & scarlet fever but stopped shy of actually
stating she had rheumatic fever.  She did followup care for 6 months but being a gymnast
they felt she was "so flexible" but in actuality she did lose some rotation in her hips.
This occurred almost 3yrs ago and recently I learned more about rheumatic fever. The specialist
said if the joint pain ever returned to immediately go to them and not go through our HMO
process. Did my daughter have "rheumatic fever"?  Should I routinely have my daughter's
heart checked out?  She is now 14 (almost 15) yrs old and still a competitive junior
olympic gymnast. My concern is she may collapse suddenly like that ice skater a few yrs ago.

Dear ms. myers-cruz,
Thank you for your question. Acute rheumatic fever is due to an unusual reaction to strep throat.  It occurs in about 0.3 % of patients with sore throat in which beta-hemolytic group A streptococci grow in throat cultures.  The age range is usually 3 to 15 years old and is rare before the age of 2 or after 25.  The symptoms include a relapsing fever, a migratory arthritis that usually involves the large joints of the lower extremities, a rash on the trunk of the body, subcutaneous nodules and a type of movement disorder called Sydenham's chorea.  Potential cardiac involvement includes electrocardiographic changes and valvular damage.
The diagnosis of rheumatic fever is based on clinical finding and the presence of strep antibodies.   Treatment for acute rheumatic fever is with high dose aspirin and antibiotics.  Rheumatic fever can be prevented by treating strep infections with antibiotics.  Due to the potential for recurrence follwing acute rheumatic fever careful follow-up is indicated and antibiotic prophylaxis is recommended for adolescents and young adults.
I hope you find this information useful.  Information provided in the heart forum is for general purposes only.  Only your physician can provide specific diagnoses and therapies.  Please feel free to write back with additional questions.
If you would like to make an appointment at the Cleveland Clinic Heart Center, please call 1-800-CCF-CARE or inquire online by using the Heart Center website at www.ccf.org/heartcenter.  The Heart Center website contains a directory of the cardiology staff that can be used to select the physician best suited to address your cardiac problem.

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