American Medical Association Family Medical Guide - American Medical Association [208]
If untreated, rheumatic fever can damage the heart, in a condition called rheumatic heart disease. The inflammation that characterizes rheumatic heart disease can cause heart muscle damage (myocarditis), an irregular heart rate (arrhythmia), or heart valve injury. Damage to the heart valves can prevent the valves from completely opening or closing, which forces the heart to work harder to pump blood. If the heart valves are damaged permanently, health problems such as congestive heart failure (see page 570) can develop.
Symptoms
The symptoms of rheumatic fever can resemble those of other illnesses and usually develop 1 to 6 weeks after a strep throat infection. (In some people, a strep infection can be so mild that it is not noticed.) Symptoms of rheumatic fever include fever; joint pain and swelling that moves from joint to joint (called migratory arthritis); a ring-shaped rash on the chest, back, or abdomen; or abnormal writhing movements of the body and limbs. The child may develop chest pain, changes in heart rate, and symptoms of congestive heart failure (such as fatigue, shortness of breath, and swelling of the legs, ankles, and feet). To prevent rheumatic fever and rheumatic heart disease, see the doctor if you or your child has symptoms of strep throat, such as swollen tonsils, swollen lymph nodes in the neck, and fever. Strep spreads easily among family members.
Diagnosis
To diagnose rheumatic fever, a doctor will take a detailed health history, listen to the child’s heart and lungs with a stethoscope, and examine the skin for a rash and the joints for pain and swelling. The doctor may take a sample from the child’s throat to check for strep throat and order blood tests to look for evidence of a streptococcal infection. He or she may order an electrocardiogram (see page 559), which records the electrical activity of the heart, and an ultrasound examination of the heart (echocardiogram; see page 561) to check for heart damage.
Treatment
In most cases, treating a strep throat promptly with antibiotics will prevent rheumatic fever. To treat rheumatic fever, a doctor may recommend drugs such as corticosteroids to reduce the inflammation, and he or she will prescribe antibiotics if streptococcal bacteria are present. He or she may also prescribe long-term treatment with antibiotics to prevent recurring strep infections, which can reactivate rheumatic fever.
Scoliosis
Scoliosis is an abnormal curvature of the spine that develops or becomes apparent during the growth spurt of puberty, between ages 10 and 12. The condition affects girls more often than boys. In most cases, the cause is unknown, but some forms can be present at birth, inherited, or related to muscle and neurologic disorders.
Symptoms and Diagnosis
In many children, the curvature of the spine is so slight that it is not noticeable. In some cases, the curvature causes the shoulders, hips, or waist to be uneven. The legs may appear unequal in length and the shoulder blades may be more prominent than usual. In severe cases, the curvature can affect the heart and lungs.
Doctors screen for scoliosis as part of a routine physical examination. If your child has scoliosis, the doctor will refer you to a bone specialist (orthopedist), who will examine your child and order X-rays to confirm the diagnosis.
Treatment
Treatment of scoliosis depends on the degree of the curvature. For a curvature of less than 20 degrees, no treatment is necessary, but a child’s spine should be examined at regular intervals. A curvature between 20 and 40 degrees is usually treated with a lightweight brace (worn under clothing) to prevent the curvature from worsening. The child may also need physical therapy to help strengthen his or her back muscles. If the brace is not effective or the curvature is more than 40 degrees, the doctor may recommend surgery to correct it.
Osteomyelitis
Osteomyelitis is a rare bacterial infection of the bone that can develop when bacteria from a contaminated wound or an infection in another part of