Rheumatic heart disease (Rheumatic endocarditis)

A hundred years ago, before we had access to effective antibiotics or preventative care, strep throat (streptococcal pharyngitis), scarlet fever, and other manifestations of Streptococcus pyogenes infection often led to death; sometimes that death was months or years after “recovery” from the disease, but it was directly caused by the reaction of the body’s immune system to the bacterial infection.

Untreated Streptococcus infections can lead to an autoimmune cross-reaction to the body’s own tissues. One of these autoimmune responses is rheumatic fever. In this condition, the heart and joints are attacked, causing them to grow vegetations (see the opened heart above) which impede blood flow and free movement of the large joints. Rheumatic fever also causes what’s known as “St. Vitus’ Dance" (chorea minor), which causes uncontrolled movements and muscle twitching, which can further impair quality-of-life and productivity.

While rheumatic fever is rare in the developed world (and almost always caught early when it does occur), it’s still painfully common in places like South-East Asia and Sub-Saharan Africa. People (largely children) who develop it often don’t know until symptoms begin to seriously manifest themselves, when the growths have reached a point where they have the potential to soon completely block the heart valves. At this point, the only cure for the patient is open-heart surgery - something that’s incredibly hard to come by in the developing world. Over 300,000 people still die of this condition every year.

Keif Davidson recently released an Academy Award-nominated short documentary called "Open Heart", following eight Rwandan children to the Salam Center in Northern Sudan. This well-built and impressively staffed charitable hospital is run by Emergency, an Italian NGO. For the children that can get there, open-heart surgery and all follow-up visits are provided for free. It’s an impressive and touching film, and the passion of the filmmaker and of the surgeons is hard to ignore.

If Streptococcal infections are treated, rheumatic fever almost never develops. But if it does, early treatment can mean that those afflicted with the condition can live happy and productive lives, and may never develop the life-threatening heart conditions associated with it. There are currently efforts to disseminate antibiotic availability for Streptococcal infections, and a mobile team is now being organized to screen for early rheumatic fever in the field. Prevention and early treatment is much cheaper for everyone, and hopefully both of these efforts will be successful in decreasing the number of people who must trek far from home for any chance at all of treatment.

Illustration: Researches on Rheumatism. F.J. Poynton and Alexander Paine, 1914.

Poster: “Open Heart” Film. Directed by Keif Davidson, in Association with Stories Of Change A Project Of and supported by the Skoll Foundation. 2013.

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