Treating acute rheumatic fever

BMJ 2003; 327 doi: https://doi.org/10.1136/bmj.327.7416.631 (Published 18 September 2003) Cite this as: BMJ 2003;327:631
  1. Antoinette Cilliers, paediatric cardiologist (amcilliers@icon.co.za)
  1. CH Baragwanath Hospital, PO Box 2588, Northcliff, 2115, Johannesburg, South Africa

    So many years, and yet we do not know if steroids should be used

    Rheumatic fever is a delayed complication of pharyngeal infection with group β haemolytic streptococci. Susceptible individuals develop a diffuse inflammatory disease of the heart, joints, brain, blood vessels, and subcutaneous tissue. Carditis is the most serious manifestation of the disease. It may culminate in chronic valvular disease and can lead to heart failure and ultimately death. The incidence of acute rheumatic fever has declined in industrialised countries since the 1950s. However, a resurgence of the disease has been noted, and new epidemics have been reported in the United States.1 Acute rheumatic fever continues to be an important cause of acquired heart disease in developing countries where it is an endemic disease.2 Open heart surgery may be needed to repair or replace heart valves in patients with severely damaged …

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