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Acute Rheumatic Fever.pptx
- 1. Rheumatic Fever Presented by Dr Gururaja R MD, DNB(Paed)
- 2. • Immunological disorder • Follows streptococcal infection • Rheumatic heart disease(RHD) • Scope of prevention • Licks joints and bites heart
- 3. Epidemiology • 5- 15 Yr age group • M = F • Incidence – 5.3/1000 • Prevalence – 0.5 -1/1000 • Common in poor socioeconomic status
- 4. Pathogenesis • H/O sore throat – 50% • Streptococcal infection • Molecular mimicry • Autoantibodies to connective tissue • Immune response • Heart is permanently damaged
- 8. • Jones criteria • Major • Carditis • Polyarthritis • Chorea • Erythema marginatum • Subcutaneous nodules • Minor • Fever,arthralgia • ESR,CRP – increased • Prolongeg PR interval • ESSENTIAL CRITERIA • Evidence of recent streptococcal inf,culture,ASO titre
- 10. • Primary episode of RF ; • Two major • One major + 2 minor • +evidence of streptococcal inf • Recurrent RF with out RHD • 2 major • 1 major + 2 minor • +evidence of streptococcal inf • Recurrent RF with RHD • Two minor • +evidence of streptococcal inf • Rheumatic chorea
- 11. Clinical features • Carditis • 60-90% • All layers of heart involved(pancarditis) • Subclinical carditis • Presents in first 2 weeks • Pericardial friction rub • Cardiomegaly • MR/AR/MS • Murmurs • Features of CCF
- 12. Clinical features • Polyarthritis • Joint swelling and pain • Large joints • Kness,ankles and elbow • Migratory • 30-50% • No residual damage
- 13. Clinical features • Chorea • Late manifestation • 3 months • Semipurposeful,jerky movements • Deranged speech • Muscular incoordination • Emotionally disturbed • F>M
- 14. Clinical features • Rheumatic nodules • Painless • Over bony prominences like elbows,shins,occiput and spine • 3-20% cases
- 15. Clinical features • Erythema marginatum • Early manifestation • Trunk • Faintly reddish • No itching • Better appreciated in fair skin
- 16. Minor criteria • Fever • Arthralgia • Previous rheumatic fever/RHD • Elevated TLC,CRP,ESR • Prolonged PR interval in ECG
- 17. Essential criteria • Elevated ASO titre • ASO > 250 • Positive throat culture • Recent Scarlet Fever
- 18. Echocardiography findings • Sensitive invg for detection of carditis • Subclinical carditis • Valve changes – Mitral,Aortic
- 19. Treatment • Bedrest – 3 weeks (without carditis) • CCF – 3months • Salt restricted diet • Penicillin – benzathine – one dose(0.6Mu<30kg- 1.2Mu<30kg) • Erythromycin – for 10 days(30-50mg/kg/day)
- 20. Treatment • Aspirin -90-(No carditis)100mg/kg/day - 10 days • Taper over 2 weeks • Steroid (Carditis/CCF) • Prednisolone – 2mg/kg/day for 12 weeks(3 + 9)
- 21. Other supportive measures • Management of CCF • Management of chorea • Haloperidol/diazepam/ carbamazepine
- 22. Primary Prevention • early Identification and Treatment of streptococal throat infection • Oral penicillin for 10 days
- 23. Secondary prophylaxis • Benzathine penicillin • 12lakh units i.m every 3 weeks>30 kg • 6 lakh units <30 kg • Duration • 5yrs- no carditis(Up to 18yr) • 10yrs – carditis (up to 25yr) • Lifelong – established RHD
- 24. THANK YOU