Saturday, September 30, 2006

Rheumatic Fever in Haiti

Acute rheumatic fever is a febrile illness which can cause arthritis, heart problems, skin rash, and a movement disorder called chorea. Rheumatic fever occurs several weeks after a pharyngeal infection with Group A beta hemolytic Streptoccus. Rheumatic fever continues unabated in developing countries. There are approximately 5-10 million cases each year in poor countries where two-thirds of the world's population lives. Children are the most likely victims between the ages of 5-9 years of age.

It is believed that the body recognizes the streptococcal germ and attacks it and also attacks the heart valves. Something in the valves reminds the immune system of the streptoccus and the valves are attacked also. Therefore, rheumatic fever can lead to damage of heart valves which causes decompensated congestive heart failure and death. We have seen many young teenagers and young adults in Haiti with severe valve problems which are due to rheumatic fever when they were younger. Without heart surgery, most of our patients die very miserable deaths.

With the introduction of antibiotics in the 1950's, there was a decline in rheumatic fever in the United States. Also, with appropriate antibiotics to prevent the recurrence of the disease, rheumatic fever is much more preventable in the developed world.

Haitians, like the 5 year old boy pictured above, lack penicillin for their strep throat, and develop rheumatic fever. His knees were very painful, swollen, and warm. I could not hear a heart murmur, so maybe he will be fortunate and escape the cardiac manifestations. Time will tell.

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