Complications of physician misdiagnosis/treatment of rheumatic fever in the United States

Rheumatic fever is an auto-immune disease caused by exposure to Streptococcus pyogenes. Over the last 50 years, reports of rheumatic fever within the United States have diminished. The decrease was attributed to the advent of penicillin in the treatment of streptococcus infections. We propose that current diagnostic and treatment methodologies may adversely increase the morbidity rate of rheumatic fever within the United States. Publication rates and interest in rheumatic fever has diminished over the last 30 years. Because of this decline, many physicians are only vaguely aware of the disorder. Additionally, the fear of antibiotic resistance has influenced the Center of Disease Control to suggest a significant decrease in the use of antibiotics by physicians. Although extremely valid for the future health and well-being of the population, such policies must be examined for each individual case carefully. The American Heart Association prescribes long-term antibiotic prophylaxis as the only current treatment; however literature reviews indicate that such therapy is rarely used. Therefore individuals diagnosed with rheumatic fever are not being treated. Additionally, because many physicians are not routinely testing for streptococcus or early signs of endocarditis, it is likely that cases of rheumatic fever will increase in the future, and many individuals may not be diagnosed until sever damage or morbidity occurs. Physician education and clear revised guide-lines are necessary to ensure adequate treatment of individuals with rheumatic fever. Misunderstandings of the disease and how it should be treated by first responders (i.e. primary care providers and pediatricians) are discussed.