I.

INTRODUCTION Rheumatic fever is a descending infection that develops as a consequence of a

streptococcus throat infection that has progressed and been left untreated. Rheumatic heart disease occurs as a consequence of rheumatic fever, (autoimmune disease) which is an inflammatory condition affecting many of the bodys tissues including the heart, brain and joints. It can affect anyone of any age or background but is more commonly seen in children. Rheumatic fever typically follow streptococcal infection by about 2-3 weeks. Fever and migratory joint pain are often initial manifestations. It has the potential of leading to rheumatic heart disease meaning that the valves of the heart can become diseased by the disorder and may become so inflamed that they cannot close fully or open properly due to stiffness. This can cause the blood in flow ineffectively through the valves and can also contribute to blood leaking backwards through the valves resulting in an accumulation of fluids. These fluids can cause enlargement of the heart and can lead to fluid buildup in the lungs and on the limbs causing swollen ankles. As the condition affects mainly the valves of the heart, the symptoms are similar to those with other conditions of the valves and can include dizziness, chest pain, shortness of breath, tiredness, tachycardia, irritability and on auscultation S 3 and/or heart murmurs may be heard. For some there may be no symptoms initially, but they can develop over time and must be treated when necessary. The cause of rheumatic fever is still not entirely understood. It is known that rheumatic fever is always preceded by an invasion of bacteria belonging to the group A beta hemolytic streptococcus family. Sooner or later, everybody has a streptococcus infection, such as a streptococcus throat. Most of us get over it without any complications. But in 1 out of every 100 children the strep infection produces rheumatic fever a few weeks later, even after the streptococcus attack has long since subsided. There are several risk factors for streptococcal infection including environmental and economical factor such as crowded living conditions, malnutrition, immunodeficiency,

poor food handling, poor sanitation and poor access to health care (lack of immunization). The invasion of streptococcus sparks the production of protective agents called antibodies. For some reason, in a kind of biological double cross, the antibodies attack not only the strep but also make war on the body's own tissues the very tissues they are called upon to protect. Researchers are now suggesting the possible reason, although all the evidence is not yet in. According to a widely held theory, the strep germ possesses constituents ( antigens ) that are similar in structure to components of normal, healthy cartilage and connective tissuesfound abundantly in joints, tendons and heart valvesin susceptible individuals. Failing to distinguish between them, the antibodies attack both. The result: rheumatic fever involving joint and valve inflammation and, perhaps, permanent scarring. Rheumatic heart disease (RHD) continues to be a common health problem in the developing world, causing morbidity and mortality among both children with a median age of 10 years, although it also occurs in adults (20% of cases). Although little longitudinal data are available, evidence suggests that there has been little if any decline in the occurrence of RHD over the past few decades. Recent reports from the developing world have documented rheumatic fever (RE) incidence rates as high as 206/100 000 and RHD prevalence rates as high as 18.6/1000. The high frequency of RHD in the developing world necessitates aggressive prevention and control measures. The major interventions for prevention and control include: (1) reduction of exposure to group A streptococci, (2) primary prophylaxis to prevent initial episodes of RF, and (3) secondary prophylaxis to prevent recurrent episodes of RE. Because recurrent episodes of RE cause increasingly severe cardiac complications, secondary prophylaxis is the most crucial feature of an effective RHD programme.