presentation

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

17. 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

18. 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

19. GOAL OF MEDICAL MANAGEMENT

Eradication of hemolytic streptococci.

Prevention of permanent cardiac damage.

Palliation of other symptoms.

Prevention of recurrence of rheumatic
fever.

20. OBJECTIVES OF NURSING
MANAGEMENT

Encourage compliance with drug
regimens.

Facilitate recovery from illness.

Provide emotional support.

Prevent the disease.