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Rhematic fever
- 2. Acute Rheumatic Fever(ARF) is a multisystem disease resulting from an autoimmune reaction to infection with group A streptococcus. It usually affects children between the 5 and 15 years and rarely in persons above 30 years.
- 3. Pathogenesis The condition is triggered by an immune mediated delayed response to infection with specific strains of group A streptococci, which have antigens that may cross react with cardiac myosin and sarcolemmal membrane protein. The antibodies produced against the streptococcal antigens cause inflammation in the endocardium, myocardium and pericardium.
- 4. Clinical Features It usually presents with fever, anorexia ,lethargy and joint pain . occurs 2-3 weeks after an episode of streptococcal pharyngitis. Other features include Skin rashes, carditis and neurologial changes.
- 5. Joint Involvement Most common feature occurs in 80% of patients involving major joints. Commonly involved joints knee, hips,ankle, shoulders, elbow & wrist Involved joints becomes red,swollen tender and the pain is usually disabling until anti inflammatory drugs are started. The typical arthritis is migratory , moving from one joint to another over a period of hours.
- 6. Carditis Manifest as pancarditis(endocarditis, myocarditis and pericarditis),occurs in 40-50% of cases Carditis is the only manifestation of rheumatic fever that leaves a permanent damage to an organ Chronic phase- fibrosis, calcification & stenosis of heart valves Mitral valve is almost always affected sometimes along with the aortic valve . Early valvular damage leads to regurgitaton . Myocardial inflammation can cause P-R interval prolongation and softening of first heart sound. c Carditis
- 7. Skin Manifestations Erythema Marginatum occurs in less than 5% of the patients. The lesions start as red macules that fade in the centre but remain red at the edges . THEY occur mainly in the trunk and the proximal extremeties and not the face. Subcutaneous nodules occur in 5-7% of patients . They are small, painless and firm over the extensor surfaces of bone or tendons. They occur 3 weeks after the onset of other manifestations. ERYTHEMA MARGINATUM
- 8. Sydenham’s Chorea It is a late neurologial manifestation that appears at least 3 months after the episode of acute rheumatic fever. More commonly seen in females . Charectirized by purposeless , involuntary movements of the hands , feet or face . Usually restricted to one side of the body. Resolves usually within 6 weeks .
- 9. Jones Criteria They are guidelines decided to help clinically diagnose rheumatic fever. Two major criteria or one major and two minor plus a history of a streptococcal throat infection are required to make the diagnosis of rheumatic fever.
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- 11. Treatment ANTIBIOTICS : All patients with ARF should receive antibiotics to treat the precipitating group A streptococcal infection. Pencillin is the drug of choice and can be given orally as phenoxymethyl pencillin 500 mg daily for 10 days or Single dose of 1.2 million units IM benzathine Pencillin G. NSAIDS: Used for the teatment of arthritis , arthralgia once the diagnosis is confirmed. CORTICOSTEROIDS: Prednisolone(1-2mg/kg/day in divided doses) should be continued until ESR is normal and then tapered off. DIAZEPAM OR HALOPERIDOL can be administered for chorea. Bed rest is essential during this period.