Is rheumatic fever making a comeback?

A stealthy form of strep throat that doesn't cause symptoms may underlie a recent increase in the number of rheumatic fever cases seen at a Utah hospital. Primary Children's Hospital in Salt Lake City recorded 62 cases so far in 1998, a larger number than in any of the previous 38 full years. This tally kindles fears that a disease once on the decline may be reawakening.

Rheumatic fever, which can cause serious heart damage, evolves from an untreated Streptococcus A infection--strep throat. The sore throat is contagious but curable with penicillin. With antibiotic treatment of strep throats, deaths from rheumatic fever heart complications have fallen from about 15,000 in 1950 to 5,147 in 1995 nationwide. Many recent fatalities among the elderly stem from childhood rheumatic fever.

When scientists reviewed 478 cases of rheumatic fever treated between 1985 and 1998 at the Salt Lake City hospital, they found that only 20 percent of the patients had sought medical attention for throat problems before coming down with rheumatic fever symptoms. Nevertheless, more than 90 percent of these patients had manufactured antibodies against strep, says Lloyd Y. Tani, a pediatric cardiologist at the hospital, who presented the findings.

The deadliest complication of rheumatic fever is heart inflammation and is probably an autoimmune response. Doctors treat mild cases of heart inflammation with an anti-inflammatory drug, such as aspirin, and bed rest. In severe cases, they prescribe steroids. In this study, of the 297 patients whose rheumatic fever led to inflammation of the heart, 12 required surgery to repair damaged valves.

The best weapon against rheumatic fever is prevention, Tani says. If doctors see any signs of rheumatic fever in the community, they should start monitoring sore throats more carefully.

From a historical perspective, the new cases of rheumatic fever present a mystery, he says. Early in this century, health officials believed that crowded living conditions and poverty led to the spread of the strep bacteria. Most of the patients in the recent study, however, weren't considered poor.