Delores Gonzales, age 9, of E1 Paso, Texas, for her question:

WHAT CAUSES RHEUMATIC FEVER?

Rheumatic fever, once called acute inflammatory rheumatism, is a serious disease that hits children and young adults. Doctors tell us that it is caused by bacteria from a special group of streptococci called the A beta hemolytic streptococci.

The streptococci that cause rheumatic fever are much like those that cause streptococcal sore throat, scarlet fever and blood poisoning. But no one knows exactly how they attack the body to cause rheumatic fever. It is estimated that about 250,000 persons in the United States contract the disease every year.

Rheumatic fever usually starts with vague, mild pains in the muscles. Because they often are so mild and occur in children, people have called them "growing pains."

But soon the pains become intense and the person's joints swell. The disease may subside in a few weeks, or may continue for many months, or even years.

Rheumatic fever is one of the greatest causes of heart diseases in young persons, although many may recover fully without heart damage. Usually at some stage of the disease, doctors find that the patient's heart has been affected.

In some patients, the involvement may be so minor that it can only be found by using an electrocardiogram. In others, it seriously affects the muscles and valves of the heart.

To those who are hit with rheumatic fever, complete bed rest is essential until all signs of fever and inflammation are gone. Doctors often use drugs of the salicylate group, such as aspirin, to ease the pain. Sometimes cortisone and ACTH are also used.

When the patient is allowed out of bed, his activities are gradually increased.

Because of modern methods of treatment, few children develop heart damage to the extent that normal activity must be curtailed. Usually, they attend regular school and enter into all but the most strenuous activities.

Sometimes rheumatic fever damages the heart valves so that they cannot completely close. Then when the heart pumps blood out into the great body vessels, some of it flows back. Doctors call the sound of this back flowing blood a murmur.

But many times the heart valves heal. At times, however, large scars may form that partially shut off the flow of blood between the heart chambers. Doctors call this condition stenosis.

Often surgery is used to correct a heart murmur or stenosis.

It is often suggested that damaged valves be corrected since when they are not working completely as they should, the heart must work harder to keep up with the needs of the body.