Rheumatic Fever

Rheumatic Fever

The term ‘rheumatic’ refers to any aches/ pain in muscles, bones or joints. Rheumatic fever is named after the complaints it causes, i.e. fever accompanied with rheumatism. Many a time, cramps or growing pains in children is often misinterpreted with rheumatic fever and feared due to the death and disability it causes. Even though there is a fall in the incidences due to the availability of advanced medical care, its diagnosis still gives terror to everyone, since it is the commonest cause of heart diseases, under the age of 18.

Fever is always considered friend since it is body’s reaction to fight against any disease. Rheumatic fever is also considered as a delayed auto immune response that usually follows a mal-treated or untreated streptococcal infection in the throat. It creates alarm for the spreading of the disease to the heart, joints, nervous system, brain and skin. In case of rheumatic fever, infective driving force attacks the human connective tissues (in heart valves, ligaments, blood vessels, subcutaneous tissues, nerves, etc.) with inflammatory exudation and proliferation. Delay in treatment of sore throat, joint pains, etc., (symptoms of rheumatic fever) may burden your heart. Unless cared for in the initial days, it will reward with disability.

“Never underestimate anyone” comes true with rheumatic fever. Likewise, there is a saying – “The heart of fool is in his mouth”. If everything is controlled in the mouth (throat) itself, nothing can go deep to attack the heart. So, if a sore throat is ignored, heart damage will be rewarded for our foolishness. Throat care in rheumatic fever should be equivalent to heart care.

Incidences – Rheumatic fever can occur in any age group of 4 – 40, but the incidences are higher in the age group of 5 – 15. It is the commonest sequence of untreated or mal-treated throat pain (pharyngitis) caused by Streptococcus. Females are most commonly affected than males. Also, females suffer more commonly from heart complaints, whereas males suffer more from joint disorders. Likewise, children suffer more commonly from heart problem and adults more commonly from joint trouble. The reason behind all this is still obscure. The incidence of rheumatic fever is often triggered by the start of winter, where it is more contagious.

Causes – Rheumatic fever is considered an auto immune response to bacterial invasion of the body. Bacteria worthily blamed for the occurrence is Group A – Beta Haemolytic Streptococcus. Even though it is clearly stated that this bacteria leads to rheumatic fever disease, it does not cause the disease in all infective cases. So, we are still in the dark about susceptibility or the exact cause of the disease.

Symptoms – Rheumatic fever symptoms start with redness and pain in the throat. The Beta haemolytic streptococcus infection harbouring in the throat, in due course (3-4 weeks) starts its cyclone with joint pains and fever, ending in damaging the joints and heart valves. Rarely, it also attacks the brain and skin. Manifestation of the complaints varies from patient to patient. Usually, acute symptoms go off within 4-6 weeks. Regarding joint pain, mostly larger joints, especially the knee, is most commonly involved. Later, the pain flits from one joint to another (knee, elbow, shoulder and ankle) with redness, swelling, heat and occasional skin eruptions (erythema) over the joints.

Regarding heart involvement, the mitral valve is most commonly affected to become fibrosed, stenosed and prolapsed. The other common accompanying complaints are muscle pain, malaise, abdomen pain, vomiting, chest pain, nose bleed, restlessness, difficulty in breathing, pneumonia, difficulty in speaking or writing, tremors, etc. In skin, non-tender subcutaneous nodules or erythema marginatum may occur giving more value to diagnose rheumatic fever easily.

Diagnosis and investigations – Nowadays, the severity or presence of rheumatic fever is scaled with antistreptolysin O (ASO titre) in the blood. The raised value, i.e. exceeding normal (200 units) is considered to be positive for rheumatic fever. The recent infection also has high ESR (erythrocyte sedimentation rate) level and leucocytosis. Other than these, other common tests usually followed are:

Throat swab & culture – to rule out the type of bacteria in the initial days of throat pain
ECG & Echo cardiogram – to rule out cardiac involvement later X-ray of chest and joints – to rule out development of complications With maltreated or uncontrolled cases, even with auscultation, rigid valve opening clicks followed by late systolic murmurs can be heard as additional sounds in heart sounds.

Complications – In case of rheumatic fever, complication often arises from two sources, i.e. one from the disease as such, and another from treatment. Complications of disease are mainly heart-related (Carditis) and joints-related (Poly arthritis). In the case of the heart, the thin delicate heart valves get infected and become thick and fibrosed. These processes cause stenosis and turbulence in the blood flow followed with prolapsed valve (leakage valve). Also rarely, neurological complications like involuntary movements, difficulty in writing and speaking can arise.

The complications of treatment are mainly that of steroids used nowadays to control infection. It weakens the immune mechanism and attracts many infection/complications later on. Also continuous use of antibiotics and pain-killers lead to further complications, especially related with the stomach and skin. Most people take care of the end result of the disease i.e., by replacing the valve and treating the arthritis. Treating the end result without controlling/treating disease will often lead to recurrence. For example – even after valvular transplantation, complications can arise again in the heart, if disease is not properly cared thereof or failed to prevent infection thereafter.

Prevention – Prevention is better than cure. Usually, rheumatic fever gets activated or reactivated with streptococcal throat infection. So, taking prevention for throat infection/cold (with medicines and preventive measures) will be the most valuable measure. The other possible way to prevent it is by raising immunity level with nutritious diet, exercise, rest and Homeopathic medicines. Since exact pathogenesis is not clearly understood, we should take care in the initial days of the disease itself, or serious complications may follow. To say in a simple manner, take care while you have throat pain or fever or you may need extra care with heart and joints.

General treatment – The advanced medical era attests no clear-cut treatment for rheumatic fever. Since no one claims complete cure, treatment aims only in eradicating streptococcal infection in the throat with antibiotics and prevent further recurrence with prolonged use of penicillin every 3 weeks (21 days). This mode of treatment often controls the infection and tapers it early. Sometimes, throat pain gets prescribed with Erythromycin, joint pain gets prescribed with pain-killers and fever, with anti-pyretic drugs.

Reactivation of the disease usually ends in carditis and disabled life. So, to avoid risk, some doctors insist on continuing penicillin therapy throughout life and some others would recommend it till the age of 30 and some others, recommend it till the age of 21 and many doctors advice to continue treatment till the age of 18. To avoid tension and outweigh the risks, it is better to continue medication till the age of 18.

Sometimes, even with penicillin treatment, some will not get normal level of ASO titre and they have throat pain and leg pain recurrently/continuously. These patients are made to take steroids to control the acute phase temporarily. But most of the times, they cannot taper them off or stop them. In advanced conditions, with valvular damage, surgery helps with replacement of damaged valves. Sometimes, mild stenosis is temporarily managed with balloonoplasty.

Homeopathic approach: Taking penicillin therapy usually suppresses the trigger for the time being only. It never raises our resistance. So, it is advised for every 21 days in Allopathy. Homeopathy treats patients (symptoms of the patients) by raising immunity. In the light of concept “similars” Homeopathic remedies expel the disease force/bacteria and make the patient more comfortable with treatment by supporting the healing process with the stimulation of the immune mechanism.

It will make our resistance go up, giving no chance for recurrence of the disease with re-infection of the same bacteria/virus. So, patients being diagnosed with rheumatic fever can be treated well with Homoeopathy to avoid any recurrence or complication.

Children often suffer from throat pain, tonsillitis, leg pain/joint pains. These complaints should be cared for properly. Parents should not ignore sore throats with salt water gargling and leg pain with simple massaging and application of pain balms, as symptoms tends to wax and wane for months/years. They should be seriously investigated in all aspects to prevent serious illnesses. Caution has to be taken when there is fever with rash/joint pains. Homeopathy can bring back ASO titre value within normal limits and make one maintain it normal without any fluctuations. In advanced cases, Homeopathy can pacify other distressing symptoms of the disease.

In the treatment of rheumatic fever, Homeopathy often proves its efficacy by controlling, preventing and curing the disease. Homeopathic treatment will provide dramatic relief and prevention in cases of rheumatic fever with sore throat and joint pains. One thing everyone should have in mind is that no medicine can revert back the structural damage, where pacifying the symptoms is the only way other than surgery.

Homeopathic medicines commonly used in cases of Rheumatic fever are Aconite, Apis, Ars alb, Baptisia, Belladonna, Bryonia, Cactus, Calc Carb, Chamomilla, Chinchona, Cimicifuga, Gelsemium, Ferrrum Phos, Kali mur, Lachesis, Merc sol, Pulsatilla, Pyrogen, Rhus tox, etc. These Medicines should be taken under the advice and diagnosis of a qualified Homeopath.

for new hope

Dr. S. Chidambaranathan, BHMS, MD (Homeo)

Laxmi Homeo Clinic

24 E. New Mahalipatti Road

Madurai, TN 625 001

India

Tel:  +91-452-233-8833 | +91-984-319-1011 (Mob)

Fax: +91-452-233-0196

E-mail:  drcheena@yahoo.com

www.drcheena.com / www.drcheena.in

(Disclaimer - The contents of this column are for informational purpose only. The content is not intended to be a substitute for professional healthcare advice, diagnosis, or treatment. Always seek the advice of healthcare professional for any health problem or medical condition.)

Treating fever

Fever must be considered a friend and not a disease.
Fever is the first alarming sign to indicate any problem in our body from external or internal factors. It is the symptom of the body’s reaction to fight against any disease. Fever mostly points to an underlying illness. In most of the cases, it is often untreated or maltreated. In both the cases, their importance in reflecting the disease is missed.
Fever is a defence mechanism which creates circumstances that are not favourable for virus or bacteria to thrive, or it kills them directly. If you are going to get rid of the fever without taking steps against the underlying disease, then you are giving way for the disease force to progress. Later you have will have to strain yourself more to eliminate the disease.
We must become aware that suppressing this symptom alone does not mean healing the patient. Also, while suppressing, the patient may feel better at first, but sooner or later, he/she the disease will return, reinforced. Although fever helps the body to fight infections by stimulating the natural defence mechanisms, fever can cause complications and even lead to death. Medicos fashionably often call it as PUO (Pyrexia of Unknown Origin) when the causative factor is uncertain after all investigations.
Normal body temperature – Body temperature is measured in Fahrenheit or Celsius (centigrade). Fahrenheit is commonly used in our country and Celsius is common in western countries. Our normal body temperature is 98.4°F or 37°C when measured orally. This may vary up to 0.5°F (0.2°C) when measured in the armpit (in case of children) or rectum.
This temperature may vary within a sharp range throughout the day due to atmospheric changes, our coverings, tissue metabolism, etc. It is somewhat less in the mornings and slightly higher in the evening. The regulatory system of the body is controlled by the hypothalamus (like a thermostat) by a nervous feedback mechanism. If the body temperature becomes very high, it makes vasodilatation (dilatation of blood vessels), sweating and decreases the temperature of the body. If the body temperature becomes very low, it produces vasoconstriction and protects the internal temperature.
Pyrogens in blood, which come from external substances such as bacteria, viruses, toxins and internal malignant or benign tumours, are the precursor of high temperature. Our skin, as one of the good barometers, also controls and regulates the water content and heat with perspiration. If humidity of the atmosphere permits, it works well. If all regulatory mechanism fail or the disease super wins, the temperature shoots up to more than 104°F, which endangers life.
Fever means the elevation of body temperature above the normal level (i.e. 98.4°F or 37°C). It is mostly associated with cold, cough, throat pain, ear pain, abdominal pain, nausea, vomiting, diarrhoea, urinary complaints, etc.
Causative factors:

• Due to infection (bacteria, virus and fungus) – for example: flu, cold, chickenpox, herpes, tonsillitis, laryngitis, pharngitis, pneumonia, endocarditis, tuberculosis, meningitis, vasculitis, breast abscess, rheumatic fever, vasculitis, pyelonephritis, cystitis, boils, appendicitis, pancreatitis, prostatitis, orchitis, otitis, etc.
• Due to infestation (parasites/worms) – for example: malaria, filariasis, amoebiasis, trichinosis, etc
• Due to drugs – for example: sulpha drugs, penicillin, overdose of any drug.
• Due to tissue necrosis – for example: myocardial infarction (heart attack), liver cirrhosis, injury, malignancy, etc.

The symptoms of fever may differ from patient to patient.

• Sudden or gradual increase in temperature
• Headache
• Body pain
• Aching joints
• Shivers (rigor)
• Rashes which may burn and itch
• Restlessness
• Sore eyes
• Coating of tongue
• Loss of taste
• Thirst
• Blisters

Emergency symptoms

• Signs of dehydration – Thirsty and dryness of body, tongue and skin
• Seizure or convulsions (often seen in children with high temperature)
• Continuous high fever more than three days
• Blabbering or confusion or delirium
• Stiff neck
• Difficulty in breathing
• Diarrhoea or repeated vomiting
• Swollen glands

Different types of fever – Usually fever is differentiated with its mode of onset and character as:
Acute – Sudden onset of temperature and has a short course
Chronic – Slow, progressive and recurrent in nature; some people, even after recovering from typhoid, function as carriers and suffer from it periodically.
Recurrent – Fever recurring often due to improper treatment.
Continuous fever – The temperature is continuous and variation is not more than 1°C and never touches normal in a whole day.
Remittent – The temperature variation is more than 2°C and never touches the normal level in a whole day.
Intermittent – The fever is on and off and is only for a few hours and for the remaining period, the temperature will be normal. Also, intermittent fever has been further classified as.
Quatidian – which occurs daily

• Tertian – which occurs on alternate days, for example – malaria fever
• Quartan – when there is a gap of two days between two episodes

Contagious – The fever spreads easily from one to another, through droplet infection or by means of contacts, for example, influenza, typhoid, chickenpox, smallpox, measles, dengue, mumps, plague, tuberculosis, jaundice and diphtheria
Non-contagious – The fever does not spread from one to another, for example, fever due to connective tissues, heart problems, malignancy, trauma, fear, metabolic disorder like gout, milk fever, etc.
Effects and complications – High fever often aggravates the already existing complaints. The process also increases tissue catabolism and dehydration which precipitates the disease with delirium, convulsions (due to cerebral oedema or circulatory shock) and finally leads to death.
For untreated or maltreated fever due to:
Respiratory infections – Pleural stitches occur as complication
Typhoid – Perforation of intestine occurs as a complication
Pneumonia – Necrosis of lung occurs as a complication
Rheumatic fever – valvular heart disorders occur as complication
Examination – will provide all information.
Examination of pulse – You can judge the temperature with the help of pulse itself. Normal pulse rate is 72-84 per minute. For every degree of rise in temperature, 10 pulses will be more. If this relationship is not there, we must be more careful with the disease:

• Slow pulse rate is noticed in typhoid and cardiac disorder
• High pulse rate is seen in septic conditions

Examination of respiratory rate – Faster respiratory rate is common in fever but it will slow down in the case of pneumonia and pleurisy
Examination of cardiac rate and sounds must be done to rule out cardiac disorders.
Examination of ear, nose and throat should be done since complaints often start here. Also examination of the patient thoroughly for eruptions, boils, injury, swelling of glands, joints and skin is a must, to rule out other causes.
The character of the fever also sometimes indicates the disease:
Evening rise of temperature indicates tuberculosis infection
Gradual increase of fever (step ladder type) indicates typhoid infection
Fever with rigor indicates septic fever such as urinary tract infection, puerperal fever, etc.
Fever with nervous involvement indicates poliomyelitis
Fever with rheumatic complaints indicates rheumatic fever or rheumatoid arthritis
Fever with loose stools indicates gastritis, food poisoning, etc.
Investigations
Routine blood and urine investigation often helps to diagnose the patient. Additionally, peripheral smear can be done to diagnose malaria and filaria when the fever is high. Mantoux test and sputum for AFB can be done to diagnose tuberculosis infection. Blood culture and widal test can be done to diagnose typhoid after three days. Bile salts and bile pigments can be done to diagnose jaundice.Ultrasound scan, CT and MRI can be done to diagnose inner diseases like cancer and tumours
Self-care treatment

Take

Bed rest in a well-ventilated, cool room until the fever subsides
Sponge bath with lukewarm water
Extra fluids to compensate for dehydration (water, juices, vegetable soups, etc.)
A light diet without oil
Extra cover with warm blankets when shivering
Avoid
Coffee, soft drinks and tea
Watching TV
Mental work even at home
General treatment – To start any treatment, a detailed case history, examination and lab investigations are necessary. In general, everyone treats fever by anti-pyretic drugs like Paracetamol, Crocin, Aspirin, etc. These drugs act as anti-inflammatory and make us sweat profuse and reduce the temperature. Since we are losing body fluids, we will become tired. So, it is safe to return to school or work after the temperature has become normal for 24 hours.
No one needs an antibiotic treatment unless the situation requires it. Antibiotic resistance is common in these days. Due to often usage, diseases also become more potent and resistant. Due to this, antibiotic doses are increasing, creating more complications by adding stress to the diseased body. Also, most of the time, fever is caused by virus (common cold). But everyone takes antibiotic treatment in spite of their ineffectiveness against viral infections.
Homeopathic approach – In Homeopathy, we treat the patients (symptoms of the patients) and not the disease. So, in Homeopathy, diagnosis with lab investigations and causative factor (bacteria or virus) are not important since the medicines are not going to act against the disease or kill the bacteria or virus directly. The resistance is sought to be improved by giving no chance for recurrence due to re-infection of the same bacteria or virus. So, a lot of patients being diagnosed only as ‘PUO’ after routine lab investigations can be easily treated in Homeopathy, by increasing the immune mechanism. But no one can deny the importance of diagnosis and laboratory investigations for the assessment of prognosis and to monitor the improvement.
In the light of concept ‘Similars’, Homeopathy is the most popular alternative medicine. Homeopathic remedies make the patient more comfortable during treatment by supporting the healing process and stimulating the immune response. Every patient has his/her own pattern of falling ill and will experience a different set of symptoms even for the same illness as per diagnosis.
In Homoeopathy, medicines are usually selected with the mode of onset and character of the disease, exciting cause, thirst, sweat, shivering, mental restlessness, characteristic symptoms of the patient, appetite, sleep and stool habit, etc. A well-selected remedy quickly supports the body mechanism and clears the complaints at the earliest.
Cure and comfort feeling (well-being sensation) can be felt only by the patient and cannot be examined or diagnosed by a doctor or lab findings. While taking anti-pyretic drugs, there won’t be a comfort feeling even after the fever subsides. But everyone can feel the well-being sensation while being treated by Homeopathy medicines even when there is fever as healing begins by the natural defence mechanism. In Homeopathy, the patient’s appetite and thirst improve to energise the body for getting better, i.e. Homeopathy treats the patient in all ways, always.
Some of the common medicines often used for fever are Aconite, Apis-mel, Ars alb, Baptisia, Belladonna, Bryonia, Eupatorium Per, Ferrum phos, Gelsemium, Rhus tox, Pulsatilla, Pyrogen.
To cure, one should have disease knowledge, drug knowledge and applicable knowledge of drugs on diseases. Disease knowledge includes study of symptoms and diagnosis of the patient with clinical findings and investigations. Drug knowledge includes study of drugs. Applicable knowledge comes only with experience which cannot be taught. So, an experienced, qualified doctor is absolutely necessary to treat fever.

for new hope

Dr. S. Chidambaranathan, BHMS, MD (Homeo)

Laxmi Homeo Clinic

24 E. New Mahalipatti Road

Madurai, TN 625 001

India

Tel:  +91-452-233-8833 | +91-984-319-1011 (Mob)

Fax: +91-452-233-0196

E-mail:  drcheena@yahoo.com

www.drcheena.com / www.drcheena.in

(Disclaimer: The contents of this column are for informational purpose only. The content is not intended to be a substitute for professional healthcare advice, diagnosis, or treatment. Always seek the advice of healthcare professional for any health problem or medical condition.)