DALLAS, Nov. 8 -- Rheumatic fever, which seemed almost eradicated in the United States in the early 1980s, is on the rise again, according to a report presented today at the American Heart Association's 71st Scientific Sessions. Rheumatic fever is an inflammatory illness that can lead to the permanent heart valve damage known as rheumatic heart disease. The heart valves must open and close properly to keep the heart working efficiently.
A similar resurgence of rheumatic fever in the mid-1980s worried medical professionals, and this time the number of cases seems to be rising even faster, says the study's lead author, Lloyd Y. Tani, M.D., of the division of pediatric cardiology at Primary Children's Hospital in Salt Lake City and a faculty member at the University of Utah.
"We're pretty concerned, but the frustrating thing is we don't know why more people are developing rheumatic fever," he says. "We've already seen 56 cases through July of 1998, which could make this our busiest year since 1985 when we had 60 for the year."
Although rheumatic fever remains a leading cause of death from heart disease for people worldwide under age 50, the incidence of the disease has been falling in this country. In 1950, when antibiotics were less available, about 15,000 people died from rheumatic heart disease, compared to 5,147 who died in 1995.
The disease process of rheumatic fever begins with a sore throat caused by the group A streptococcus bacteria -- an infection known as strep throat -- which can be treated with antibiotics. If untreated, some people develop rheumatic fever, which may affect the heart and result in rheumatic heart disease.
Patients with rheumatic fever may also have a form of arthritis that travels from joint to joint and chorea -- jerking movements that indicate neurological impairment -- which can linger for months. Eventually, the arthritis and chorea go away, but the heart valve damage may be permanent. Damaged heart valves either fail to close completely or will not open all the way.
Researchers reviewed the cases of 478 people with rheumatic fever who were treated at the Salt Lake City children's hospital between 1985 and 1998. More than two-thirds of the patients had no history of sore throat, although over 90 percent had elevated levels of antibodies that confirmed a recent strep infection. Heart inflammation, called carditis, was found in 62 percent of the cases, arthritis in 43 percent and chorea in 33 percent. Surgery to repair or replace damaged heart valves was required in 12 of the 297 patients with carditis.
Tani says the study should raise awareness about the disease resurgence and stress the importance of developing a system to control what could become a significant health problem for other parts of the country.
For instance, individuals who have rheumatic fever once are more prone to repeat episodes, he says. "Doctors should prescribe continual monthly injections or daily oral antibiotics to help prevent repeated illness. People with heart damage from rheumatic fever also need to take antibiotics before dental or surgical procedures to reduce the risk of bacterial endocarditis," says Tani. Bacterial endocarditis is an infection of the heart.
"And if somebody, particularly a child between the ages of five and 15, develops a mild sore throat and the throat appears inflamed, a throat culture should be done, especially in an area where rheumatic fever is being seen in increased numbers, like here in Salt Lake City," Tani says.
Researchers say more studies are needed to understand why the disease is re-emerging.
"We are in a unique position to learn why we are seeing this resurgence of rheumatic fever," says Tani. "We have been trying to determine whether there are any environmental differences linked to this resurgence. In the early 1900s and in developing countries today, high incidence of rheumatic fever was thought to be related to socioeconomic conditions such as crowding and poor nutrition. That has not been the case with what we've found since the mid-1980s. Most of the patients are not from lower socioeconomic backgrounds. They have good nutrition and they are not living in crowded conditions."
By treating strep throat with penicillin or other antibiotics, doctors can usually prevent rheumatic fever from developing, he says.
"There have been a few patients who received antibiotics and went on to develop rheumatic fever," Tani says. "A contributing factor might be that some people take antibiotics for a couple of days and stop when they feel better. It's very important to take all of the prescribed medicine.
Co-authors are L. George Veasy, M.D.; L. LuAnn Minich, M.D.; Robert E. Shaddy, M.D.; Herbert D. Ruttenberg, M.D.; and Garth S. Orsmond, M.D.
For more information Nov. 8-11
contact Cathy Yarbrough or Brian Henry
Dallas County Convention Center
(214) 853-8056