From sore throat to life-threatening complications

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A girl heart patient being treated at Ho Chi Minh City Medical University Hospital. Photo by Thanh Tung

Around a year ago, a man was admitted to Ho Chi Minh City Medical University Hospital with half his body paralyzed by a stroke that had also severely impaired his speech. 

Doctors diagnosed him with rheumatic heart disease, or rheumatic fever, which has formed necrosis and verrucae along the lines of closure of the heart valves.

They said the disease can start out as mildly as a sore throat, but develop serious and even fatal complications when the heart or the central nervous system is damaged.

The disease is an inflammatory one following a Streptococcus pyogenes (a Gram-positive bacterium) infection such as sore throat or scarlet fever, doctors said. It is caused directly by the cross-activity that involves the heart, joints, brain or skin.

It is characterized by major structural changes of the valve include leaflet thickening, commissural fusion, and shortening and thickening of the tendinous cords, and so named because of its similar presentation to rheumatism.

The valvular damage leads to heart failure, pulmonary hypertension, or blood clots in the heart chambers that would move around the cardiological system and cause artery blockage, including in the brain.

Global tests show that the disease commonly appears in children between the ages of six and 15, and only 20 percent of first-time attacks occur to adults.

The Hanoi Health Department said on its website earlier this year that around 0.3 percent of children between ages 5 and 15 in Vietnam are suffering from the disease.

Dr. Nguyen Duc Thanh from Ho Chi Minh City Medical University Hospital said signs of sickness start around five to seven days after the infection, with a fever, painful and swollen joints, and sometimes, rashes.

The heartbeats also sound fast and irregular, Thanh said, noting that treatment should be sought as soon as the signs are noticed, so that severe developments can be prevented.

He said the treatment mainly involves antibiotics, and can take five to ten years, or even a lifetime. Ngo Van D., the patient at the HCMC hospital, had to receive a replacement of his heart valves to prevent serious damage to his brain.

Doctor Nguyen Khac Hien said in a Tuoi Tre report that a child diagnosed with rheumatic heart disease should be given antibiotic shots once a month for at least five years, or until he/she is 18 years old. The shots can be taken until age 25 to reduce the chance of recurrent attacks.

Pediatric doctor Nguyen Thi Kim Thoa from HCMC said infected children should take rest and staying at home because the disease is infectious. They can go back to class after taking antibiotics and the fever is gone.

Thoa told the Nguoi Lao Dong newspaper that children can be protected from the disease in the first place by being taught to maintain good hygiene and how to avoid catching a cold. They should drink enough water, get regular exercise, and stay away from dirt, tobacco smoke, and cold air.

Switzerland-based World Heart Federation, an international NGO, says on its website that acute rheumatic fever can be prevented by treatment of acute throat infections caused by the bacteria, with up to 10 days of an oral antibiotic or an intramuscular penicillin injection.

It said that the disease has been reported more among developing countries due to overcrowding, poor housing conditions, poor nutrition and lack of access to healthcare. Improved living conditions and the availability of antibiotics for treatment of Streptococcus pyogenes infection have helped put the disease under better control in developed countries.

The disease kills 233,000 people worldwide every year, it said, noting that up to one percent of all school children in Africa, Asia, the Eastern Mediterranean region, and Latin America show signs of the disease.

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