Rheumatic fever 431

and maintains a healthy cardiorespiratory system. A respirator may be necessary if breathing becomes too slow; the body may be cooled and barbiturates given to slow metabolism and lower intracranial pressure. Small quantities of insulin may be given to increase glucose metabolism, cor-ticosteroids to reduce brain swelling, and diuretics to increase fluid loss.

over the years the prognosis for children with Reye's syndrome has improved; early diagnosis and better treatment have reduced the mortality rate to about 20 percent in recent years. Incidence of Reye's syndrome has fallen dramatically since its discovery.

rheumatic fever An inflammatory disease that may appear as a delayed reaction to inadequately treated strep throat, which can damage the heart. About 1 percent to 3 percent of untreated children come down with rheumatic fever from 10 days to six weeks after getting over a strep throat or scarlet fever. Rheumatic fever usually appears in children between five and 18 and may affect the brain, joints, skin, or other tissues. once diagnosed, the disease will tend to recur whenever the child gets a strep infection.

By the 1980s, the use of penicillin led to a dramatic drop in rheumatic fever in the United States. However, the disease has not been eradicated; today it involves a much more severe form that causes heart damage and death. Since 1985 there have been outbreaks in 24 states, especially Utah, ohio, and Pennsylvania.

Researchers believe the resurgence can be traced to a reemergence of certain strains of bacteria (group A strep). of the 80 different strains of group A strep, only a few can cause rheumatic fever. one of these strains of virulent bacteria killed Muppet creator Jim Henson in 1990.

Cause

Rheumatic fever is a delayed complication of group A strep infection, usually following either a strep throat or scarlet fever. It occurs because the patient's body creates antibodies to get rid of toxins produced by the strep bacteria; in the process, those antibodies mistakenly attack the host's own tissues in the joints, heart, skin, or nervous system. Scientists are not sure why some people develop rheumatic fever, but it may be a combina tion of the type of bacteria and the genetics of the infected person.

Symptoms

The onset of the disease is usually sudden, usually about one to eight weeks after recovery from scarlet fever or a sore throat. Early symptoms include fever, joint and muscle pain and swelling, nose bleeds, stomach pain, and vomiting. Joint pain usually affects the knees, hips, wrists, elbows, and shoulders and may move from one site to the next. other symptoms include palpitations, chest pain, and heart failure.

Late signs of rheumatic fever are a clumsiness and awkwardness; as the symptoms progress, the child develops irregular body movements or twitching that can become severe, sometimes including the tongue and facial muscles. This group of symptoms is called "Sydenham's chorea" or "St. Vitus' Dance." Fortunately, these movements do not last long and disappear without long-term damage.

Although most symptoms disappear within weeks to months, half the time the condition damages the heart valves. The mitral valve of the heart is most often affected, although the aortic valve also may be damaged. occasionally, the heart muscle itself and the outside covering of the heart may become inflamed. In the most severe infections, heart failure may result. This severe heart damage most often occurs in children who have several attacks of rheumatic fever, which is why it is so important to prevent future repeated attacks with prophylactic antibiotics.

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