Cape Town - It often feels like nothing more than a sore throat or fever, with many sufferers mistaking it for a severe flu, but rheumatic fever is killing young South Africans in numbers.
Dr Philip Herbst, a senior lecturer and cardiologist at Stellenbosch University and Tygerberg Hospital, says even though this disease can be easily treated with antibiotics, in many who lived with it, this was often missed, resulting in needless heart diseases in young children and the youth.
Poor children remained the worst affected, with overcrowding, malnutrition and limited access to antibiotics contributing to the spread of the disease, which is caused by streptococcal throat infection.
Rheumatic fever is an inflammatory disease that develops as a result of infections such as strep throat or scarlet fever.
It affects mainly those between the ages of five and 21 and, if left untreated, can result in permanent damage to the heart valves – rheumatic heart disease.
The illness is so named because of its similarity in presentation to rheumatism, including swelling, shortness of breath and joint pain.
Highlighting this week as Rheumatic Fever and Rheumatic Heart Disease Week – Herbst said:
“Many of the symptoms are similar to that of the flu and more than 95 percent of people never realise they have had rheumatic fever”.
Herbst explained that in a group of people genetically predisposed to the disease, the antibodies released by the body to fight the streptococcal infection often attacked a person’s heart tissue, damaging the heart’s mitral valve (the valve between the left atrium and the left ventricle of the heart, which has two tapered cusps). This could then lead to either narrowing of the valve or causes leakage in the long term.
Rheumatic fever is an acute infection, while rheumatic heart disease (RHD) is the chronic condition resulting from the valve damage caused by rheumatic fever.
It is estimated that about a million children in Africa could be affected by RHD, and it is believed that as many as 30 per 1000 kids may be affected in certain high risk areas in South Africa.
“The disease follows the economic gradient, and the poorer communities, with more overcrowding and difficult living conditions, are worst affected. In South Africa, with its drastic socio-economic differences, one might find a high prevalence in certain lower-income areas, but not a single case in a high-income area just up the road.
“Looking at prevalence figures may therefore be a very local affair and difficult to generalise to a population as a whole,” he said.
While rheumatic fever is not infectious, streptococcal throat infection – which developed into rheumatic fever in susceptible individuals – gets transmitted through the air or contact with an infected person.
The more bouts of rheumatic fever a child experienced, the higher the risk that the child would develop the heart disease.
“We also see a lot of young women in their twenties or thirties presenting with serious complications during pregnancy.
“Their hearts, damaged by bouts of rheumatic fever in childhood, can’t cope with the demands of pregnancy and they end up in the emergency room. It is an important cause of maternal deaths,” he said.
To understand the extent of rheumatic heart disease in the province, Stellenbosch University and Tygerberg Hospital were conducting a large screening programme called “Echo in Africa”, where they tested for the disease in children from Khayelitsha and Ravensmead.
Cape Argus