Q: I had high fever accompanied by sore throat 2 months ago. The doctor first treated me with Levomac 250 mg once a day, for 5 days. When I didn't feel better, she gave me Bicef 500, twice a day, for 5 days. Though my sore throat was cured, but I still had body and joint pain, specially my right wrist and right knee. Another doctor asked me to get an ASO titre done. The result is: ASO titre: positive 400 iu/ml < 200iu/ml; haemoglobin: 10.9 g/dl; Total count: 8200 cells/cumm; Neutrophils 56%; Eosonophils 04%; Lymphocytes 39%; Monocytes 01%; Basophils 00%; ESR (westgren) 38 mm/hr. Do I have rheumatic fever? Has it already affected my heart? I still have joint pains off and on. What form of treatment should I follow?

A:Acute rheumatic fever is an inflammatory process occurring as a delayed effect of an upper respiratory tract infection by group A streptococci. The clinical features are extremely variable and there is still no specific diagnostic test for it. Individuals who have suffered from it once are predisposed to recurrent episodes of group A streptococcal infections. The frequency of infection and virulence of the bacterial strain determine the incidence of the disease in the community. Acute rheumatic fever causes chronic progressive damage to the heart and its valves with fleeting inflammation of several joints (migratory) polyarthritis). Joint involvement may manifest as mild pain to overt arthritis. The larger joints are involved most frequently, such as the knees, ankles, elbows, and wrists. Involvement of the heart causes long-term morbidity. In approximately 75% of cases, the acute attack lasts only 6 weeks with nearly 90% cases resolving in about 3 months. Only 5% of patients have symptoms that last beyond 6 months. The diagnostic criteria used by the American Heart Association include major criteria (carditis, migratory polyarthritis, subcutaneous nodules, erythema marginatum & chorea) and minor criteria (clinical and laboratory findings). In addition to evidence of a previous streptococcal infection, the diagnosis requires 2 major criteria or 1 major plus 2 minor criteria. No specific confirmatory laboratory tests exist. However, several laboratory findings indicate continuing rheumatic inflammation. These include: Streptococcal antibody tests (ASO titre) which reveal preceding streptococcal infection; Throat culture (to isolate group A streptococci); Acute phase reactants (ESR, C-reactive protein and leukocytosis); Anemia and ECG (prolonged PR interval). As should be evident, the diagnosis requires a constellation of symptoms and laboratory tests. Please consult an infectious disease specialist or a cardiologist to allay apprehension.