Rheumatic fever

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Rheumatic fever

  1. 1. RHEUMATIC FEVER
  2. 2. PREVALENCE  There is a marked decline in the prevalence. - Improved standards of living - Literacy rate - Medical facilities - Penicillin : Treat streptococcal infections
  3. 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. 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. 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. 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. 7. DIAGNOSTIC EVLUATION
  8. 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. 9. INVESTIGATION Increased level of antibodies against streptococci.  Positive throat culture for Group A streptococcus  Recent scarlet fever. 
  10. 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. 11. CHEST RADIOGRAPH OF AN 8 YEAR OLD PATIENT WITH ACUTE CARDITIS BEFORE TREATMENT
  12. 12. SAME PATIENT AFTER 4 WEEKS
  13. 13. SUBCUTANEOUS NODULE ON THE EXTENSOR SURFACE OF ELBOW OF A PATIENT WITH ACUTE RF
  14. 14. ERYTHEMA MARGINATUM ON THE TRUNK, SHOWING ERYTHEMATO US LESIONS WITH PALE CENTERS AND ROUNDED OR SERPIGINOUS MARGINS
  15. 15. CLOSER VIEW OF ERYTHEMA MARGINATUM IN THE SAME PATIENT
  16. 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. 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. 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. 19. OBJECTIVES OF NURSING MANAGEMENT  Encourage compliance with drug regimens.  Facilitate recovery from illness.  Provide emotional support.  Prevent the disease.

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