Rheumatic fever caused by strep infection

Dear Doctors: I had rheumatic fever when I was 5 years old. My heart is fine, but after my illness, I had trouble learning. I’m 79 now and still struggle to understand some things, especially the age we live in, with electronic everything. What does rheumatic fever do to the body? Can it affect the brain?

Dear Reader: Rheumatic fever is a complex disease that can develop when a strep infection goes untreated. This infection typically is strep throat, and sometimes it is scarlet fever. Both are caused by infection with group A streptococcal bacteria.

Rheumatic fever occurs mainly in children from 5 to 15 years old, and it usually causes symptoms one to five weeks after infection. When faced with an ongoing strep infection, the child’s immune system can go into overdrive. But instead of targeting just the bacteria, it attacks the body’s own tissues, as well. For this reason, rheumatic fever is regarded as an autoimmune disease. Although the reasons why this occurs are not fully understood, researchers believe that certain molecular features of group A streptococcal bacteria trick the body into attacking its own tissues. This is a mechanism known as molecular mimicry.

Because rheumatic fever affects the heart, blood vessels, joints, skin and brain, it has a wide range of symptoms. These include fever; pain, swelling, heat and tenderness in the joints of the elbows, wrists, ankles and knees; a distinctive rash; shortness of breath; chest pain; a racing heartbeat; weakness; and persistent fatigue.

You asked in your letter about the effect of rheumatic fever on your brain, but also said that your family doctor’s primary worry was about the health of your heart. His concern is well-founded. Although the word “rheumatic” refers to inflammation of the joints, connective tissues and muscles, the disease often adversely affects the heart. Widespread inflammation can do damage to the heart muscle and the heart’s valves.

 Elizabeth Ko, MD and Eve Glazier, MD

While heart issues are seen as a primary risk of rheumatic fever, the disease also can affect the brain. Neurological symptoms include a disorder known as Sydenham chorea, which can appear up to six months after the infection has cleared. It’s estimated to occur in up to one-fourth of cases of rheumatic fever, and affects girls more often than boys. Symptoms can be both physical and cognitive, and can range from mild to severe. They include muscular weakness; jerky, uncoordinated movement; facial tics; slurred speech; and a stumbling gait. Some patients have trouble with reading and writing, and they may experience anxiety or emotional instability.

Although most children recover completely, in rare cases the condition can persist or recur. There is some evidence of a link between recurrent cases of Sydenham chorea and the later development of obsessive-compulsive disorder, autism and attention deficit/hyperactivity disorder. Up to 80% of those with Sydenham chorea also develop myocarditis, which is inflammation of the heart.

So much time has elapsed since your original illness, it would be difficult to say if Sydenham chorea has played a role in your life. One thing we can assure you of, however, is that when it comes to the complexities of the digital world, you are not alone in feeling a bit overwhelmed.

The primary care physicians at UCLA Health offer everything from routine screenings and disease prevention to coordinated treatments for a wide range of health conditions. Talk to your provider about your concerns. Learn more and schedule an appointment.

(Send your questions to askthedoctors@mednet.ucla.edu, or write: Ask the Doctors, c/o UCLA Health Sciences Media Relations, 10960 Wilshire Blvd., Suite 1955, Los Angeles, CA, 90024. Owing to the volume of mail, personal replies cannot be provided.)


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