RHEUMATIC FEVER
Definition
"Rheumatic fever, or RF, is an autoimmune disease that may occur after a group A streptococcal throat infection that causes inflammatory lesions on connection tissues, especially that of the heart, joints, blood vessels, and subcutaneous tissue. Rheumatic fever affects the joints, heart, skin, and nervous system." (medicinenet.com)
Causes: Preceded by a throat infection, with group A beta-hemolytic strep throat. The bacterium causes an autoimmune inflammatory response in some people which leads to the symptoms described below by the Jones Criteria.
Schoolchildren & AF: In children 5-15 years of age, strep throat infections are very common and present as a sudden onset of throat pain, fever, headache, and abdominal pain. Most providers recognize these symptoms and test for the infection. Prevention of rheumatic fever requires the recognition and diagnosis of group A strep throat infections and appropriate antibiotic therapy.
Instructional Strategies
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Teacher should be aware of symptoms such as fever, shortness of breath in students, skin rashes on the chest/abdomen, or bumps under the skin.
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Important to know that strep infections are contagious but rheumatic fever is not. Children displaying signs of strep throat should be sent to the nurse.
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Some students may need to step out of the classroom throughout the day to be treated with anti-inflammatories such as aspirin or corticosteroid. Teachers need to be aware of this and be willing to assist the child with classwork they missed during their time with the nurse.
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Depending on the severity of the student’s disease and its impact on the heart, they may be placed on monthly doses of antibiotics or even bed rest from 2-12 weeks. Teacher must be willing to provide the student with necessary materials so that the student can stay caught up on schoolwork, even while at home.
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If a student is diagnosed with rheumatic fever, it is important for the teacher to be understanding. This may include extending due dates and even tutoring the student.
Links for Support
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https://www.medicinenet.com/rheumatic_fever/index.htm#what_are_the_complications_of_rheumatic_fever
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https://www.heart.org/idc/groups/heart-public/@wcm/@hcm/documents/downloadable/ucm_300321.pdf
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http://www.stanfordchildrens.org/en/topic/default?id=rheumatic-fever-90-P01728
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http://www.chop.edu/conditions-diseases/rheumatic-fever-and-rheumatic-heart-disease
Research
Australia has one of the highest rates of acute rheumatic fever (ARF) and rheumatic heart disease (RHD) in the world. Menzies is a school of health research in Australia and mainly targets primary and secondary prevention of ARF and RHD. This link provides background information of RF, research focus, research impacts, and different projects.
This article from 2017 focuses on community initiatives to prevent RF. It focuses on rheumatic fever in New Zealand and the amount of children it affects under the age of 13. Professor Diana Lennon, from University of Auckland, examines the prevention program in schools and its positive impact (decrease in RF) among primary children.
This is an older article from 2011; but, it contains a lot of information regarding proposed research priorities for the next decade. This article focuses on ways to identify people with Rh earlies, in hopes of preventing heart disease. The author outlines her efforts to bring a global solution to rheumatic fever.
Other Useful Information
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Prior to the broad availability of penicillin, rheumatic fever was a leading cause of death in children and one of the leading causes of acquired heart disease in adults.
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Rheumatic fever may cause long-term damage to the heart and the valves. Valve replacement may be necessary if patient doesn’t respond to medication. This is a major complication of rheumatic fever.
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The jones criteria is used to help doctors make the clinical diagnosis of rheumatic fever, since there is no simple test for it. 2 major criterias or 1 major + 2 minor + history of strep are required for diagnosis:
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Jones major criteria for diagnosis includes arthritis in several joints, heart inflammation, nodules under skin, rapid or jerky movements, & skin rashes.
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Jones minor criteria for diagnosis includes fever, high inflammation, joint pain, EKG change, etc.
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These are also the signs and symptoms of rheumatic fever. The symptoms develop within two to three weeks of a strep infection. First symptoms are painful joints.
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