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Rheumatic fever

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  • 1. RHEUMATIC FEVER
  • 2. PREVALENCE  There is a marked decline in the prevalence. - Improved standards of living - Literacy rate - Medical facilities - Penicillin : Treat streptococcal infections
  • 3. INCIDENCE IN INDIA • The reported incidence of RF in India varies from 0.42 – 10.9 per 1000. • Rheumatic heart disease (RHD): 0.56 – 11 per 1000. • Recent studies using echocardiography show a incidence of RHD : 0.12 – 0.67 per 1000.
  • 4. DEFINITION  Rheumatic fever is a poorly understood inflammatory disease that occurs after infection with Group A : β- hemolytic streptococcal pharyngitis.  It is a self- limited illness that involves the joints, skin, brain, serous surfaces and heart.
  • 5. ETIOPATHOGENESIS  Systemic disease  Affects connective tissue  Can occur after an untreated Group A : βhemolytic streptococcal pharyngeal infection. Develops after 2 to 6 weeks post infection
  • 6. PATHOPHYSIOLOGY Group A Streptococcus Pyogens Cell wall consist of M- Protein antigenic Highly Antibody is generated against M protein Antibody react with cardiac myofiber protein, smooth muscles Causes release of cytokine Leading to tissue destruction
  • 7. DIAGNOSTIC EVLUATION
  • 8. DIAGNOSIS • Diagnosis follow a set of guidelines : Given by Dr. T Ducklet Jones in 1944, revised by AHA in 1965, latest revised by WHO in 2003. • Modified Jones Criteria : Two major manifestation or one major and two minor.
  • 9. INVESTIGATION Increased level of antibodies against streptococci.  Positive throat culture for Group A streptococcus  Recent scarlet fever. 
  • 10. CLINICAL FEATURES : MAJOR CRITERIA      Carditis Chorea Erythema marginatum Polyarthritis Subcutaneous nodules MINOR CRITERIA       Arthralgia Previous RF or RHD Fever Elevated ESR Increased CRP Prolonged PR interval on ECG
  • 11. CHEST RADIOGRAPH OF AN 8 YEAR OLD PATIENT WITH ACUTE CARDITIS BEFORE TREATMENT
  • 12. SAME PATIENT AFTER 4 WEEKS
  • 13. SUBCUTANEOUS NODULE ON THE EXTENSOR SURFACE OF ELBOW OF A PATIENT WITH ACUTE RF
  • 14. ERYTHEMA MARGINATUM ON THE TRUNK, SHOWING ERYTHEMATO US LESIONS WITH PALE CENTERS AND ROUNDED OR SERPIGINOUS MARGINS
  • 15. CLOSER VIEW OF ERYTHEMA MARGINATUM IN THE SAME PATIENT
  • 16. TREATMENT No specific treatment. Management is symptomatic. 1. Bed rest - It is advised in all patients with carditis till activity subsides. - Immobilization may have to be continued for 2–3 months. 2. Diet - Salt restriction
  • 17. 3. Antimicrobial Therapy - Penicillin :4L units I/M BD * 10 days. - Benzathine penicillin - Erythromycin : 20-30 mg/kg BD 4. Suppressive Therapy - Aspirin - Steroids 5. Management of Chorea - Complete physical and mental rest - Phenobarbitone : 3-5gm/kg/day -Chlorpromazine, diazepam, haloperidol provides sedation
  • 18. GOAL OF MEDICAL MANAGEMENT  Eradication of hemolytic streptococci.  Prevention of permanent cardiac damage.  Palliation of other symptoms.  Prevention of recurrence of rheumatic fever.
  • 19. OBJECTIVES OF NURSING MANAGEMENT  Encourage compliance with drug regimens.  Facilitate recovery from illness.  Provide emotional support.  Prevent the disease.

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