If cardiology nurse Mary-Anne Ross could give one piece of advice to parents, it’s this: don’t ignore a sore throat.
“Particularly if your children or young people are Māori or Pacific. Go to the GP, get swabbed and treated.”
Mary-Anne works at Auckland City Hospital. The nurse, who specialises in rheumatic fever and rheumatic heart disease, says one of the most devastating aspects of rheumatic fever and heart disease is that it’s preventable.
Rheumatic fever is an auto-immune inflammatory disease that can develop after a bout of strep throat: the bacterial infection Group A streptococcal pharyngitis. Untreated, rheumatic fever can damage the heart’s valves, leading to rheumatic heart disease.
Doctors are generally alert to rheumatic fever’s symptoms, which can include a fever, sore joints and sometimes a rash, Mary-Anne says.
However, even the experts get it wrong, with the most common symptom – joint pain – sometimes put down to sports injuries or even arthritis, she says.
“We still miss rheumatic fever diagnoses sometimes as the disease presentation is complex and requires several tests to confirm. Many of these need to be done in hospital, so by the time people do present they’re sometimes really sick, and may need heart surgery.”
If caught in time, treatment can be started to avoid recurrent rheumatic fever episodes that can lead to progressive heart valve disease. But the treatment is no quick fix: after a short hospital stay, patients need a penicillin injection every 28 days for at least 10 years preventing the strep infection that causes the autoimmune response that develops into rheumatic fever, Mary-Anne says.
“It’s a really, really tough treatment plan, but the only one we have.”
A rheumatic fever or heart disease diagnosis is devastating for families, Mary-Anne says.
“Parents have to stay with children in hospital, sometimes leaving other children at home. They might struggle financially or lose their jobs because even though it’s just a couple of weeks in hospital, the child will need to stay off school for several weeks.”
Then, there’s the 10-year treatment. “It’s hard to understand how difficult that journey is.”
The nurse credited the “amazing” families and nurses she works with; 99% of children stick to the gruelling monthly injection schedule.
With Maori and Pasifika making up 96% of rheumatic fever cases, these communities needed to be especially vigilant, Mary-Anne says.
“The most important thing is taking a child with a sore throat to their primary care GP and having their throat swabbed.”
Sometimes, that might mean being a little pushy, which can be difficult. “A lot of people don’t like asking for things of their GP; or seeming bossy.”
But a throat swab can catch the infection before it triggers rheumatic fever. Strep is treatable, with a short course of antibiotics, preventing a lifelong disease that often results in heart surgery.
“It’s entirely preventable, that’s the sad thing about it. I think we can continue to do better in raising awareness of rheumatic fever and heart disease.”
