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RHEUMATIC FEVER  PRESENTED BY ADNAN AHMED BHUTTO Hamdard University  Karachi, Pakistan 05/22/10
OBJECTIVES ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],05/22/10
ETIOLOGY ,[object Object],[object Object],[object Object],05/22/10
EPIDEMIOLOGY ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],05/22/10
PATHOGENESIS ,[object Object],[object Object],[object Object],05/22/10
Group A Beta Hemolytic Streptococcus ,[object Object],[object Object],[object Object],[object Object],05/22/10
05/22/10 Diagrammatic structure of the group A beta hemolytic streptococcus Cytoplasm Cyto.membrane Peptidoglycan Group carbohydrate Protein   antigens Cell wall Capsule Antigen of outer protein cell wall of GABHS induces antibody response in victim which result in autoimmune damage to heart valves,  sub cutaneous tissue,tendons,  joints & basal ganglia of brain
Pathologic lesions  ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],05/22/10
Rheumatic Carditis Histology  05/22/10
Histology of Myocardium in Rheumatic Carditis  05/22/10
CLINICAL FEATURES ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],05/22/10
05/22/10 Showing  ARTHIRITIS   In knee joint
2. Carditis  ,[object Object],[object Object],[object Object],[object Object],05/22/10
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],1.Carditis (Contd.) 05/22/10
05/22/10 Rheumatic heart disease . Abnormal mitral valve. Thick, fused chordae
05/22/10 Another view of thick and fused mitral valves in  Rheumatic heart disease
05/22/10
3. Sydenham’s Chorea ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],05/22/10
05/22/10 ,[object Object],[object Object],3. Sydenham’s Chorea
05/22/10
4.Subcutaneous Nodules ,[object Object],[object Object],[object Object],[object Object],[object Object],05/22/10
5.Erythema   Marginatum ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],05/22/10
05/22/10 OTHER CLINICAL FEATURES ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
05/22/10 LABORTARY INVESTIGATIONS ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Diagnosis ,[object Object],[object Object],[object Object],05/22/10
05/22/10
Exceptions to Jones Criteria ,[object Object],[object Object],[object Object],05/22/10
Differential diagnosis ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],05/22/10
treatment ,[object Object],[object Object],[object Object],[object Object],05/22/10
05/22/10 STEP I :  Primary Prevention of Rheumatic Fever  (Treatment of Streptococcal Tonsillopharyngitis)   Agent   Dose  Mode   Duration Benzathine penicillin G 600 000 U for patients  Intramuscular  Once  27 kg (60 lb)  1 200 000 U for patients >27 kg    or  Penicillin V Children: 250 mg 2-3 times daily  Oral  10 d  (phenoxymethyl penicillin)  Adolescents and adults:    500 mg 2-3 times daily For individuals allergic to penicillin Erythromycin:  20-40 mg/kg/d 2-4 times daily  Oral  10 d Estolate  (maximum 1 g/d   or  Ethylsuccinate 40 mg/kg/d 2-4 times daily  Oral  10 d  (maximum 1 g/d)
Step II:   Anti inflammatory treatment 05/22/10 Clinical condition  Drugs
Step III:  Supportive Management &    Management of complications ,[object Object],[object Object],[object Object],[object Object],05/22/10
05/22/10 STEP IV :  Secondary Prevention of Rheumatic Fever    (Prevention of Recurrent Attacks)   Agent   Dose   Mode Benzathine penicillin G 1 200 000 U every 4 weeks*   intramuscular or Penicillin V 250 mg twice daily   Oral or Sulfadiazine   0.5 g once daily for patients 27 kg (60 lb  Oral    1.0 g once daily for patients >27 kg (60 lb) For individuals allergic to penicillin and sulfadiazine Erythromycin 250 mg twice daily   Oral *In high-risk situations, administration every 3 weeks is justified and recommended
05/22/10 Duration of Secondary Rheumatic Fever Prophylaxis     Category Duration Rheumatic fever with carditis and  At least 10 y since last residual heart disease    episode and at least until (persistent valvar disease * )   age 40 y,  sometimes lifelong   prophylaxis      Rheumatic fever with carditis 10 y or well into adulthood, but no residual heart disease   whichever is longer    (no valvar disease*)    Rheumatic fever without carditis 5 y or until age 21 y,  whichever is longer *Clinical or echocardiographic evidence.
Prognosis ,[object Object],[object Object],[object Object],05/22/10
05/22/10

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Rheumatic Fever by Adnan Bhutto

  • 1. RHEUMATIC FEVER PRESENTED BY ADNAN AHMED BHUTTO Hamdard University Karachi, Pakistan 05/22/10
  • 2.
  • 3.
  • 4.
  • 5.
  • 6.
  • 7. 05/22/10 Diagrammatic structure of the group A beta hemolytic streptococcus Cytoplasm Cyto.membrane Peptidoglycan Group carbohydrate Protein antigens Cell wall Capsule Antigen of outer protein cell wall of GABHS induces antibody response in victim which result in autoimmune damage to heart valves, sub cutaneous tissue,tendons, joints & basal ganglia of brain
  • 8.
  • 10. Histology of Myocardium in Rheumatic Carditis 05/22/10
  • 11.
  • 12. 05/22/10 Showing ARTHIRITIS In knee joint
  • 13.
  • 14.
  • 15. 05/22/10 Rheumatic heart disease . Abnormal mitral valve. Thick, fused chordae
  • 16. 05/22/10 Another view of thick and fused mitral valves in Rheumatic heart disease
  • 18.
  • 19.
  • 21.
  • 22.
  • 23.
  • 24.
  • 25.
  • 27.
  • 28.
  • 29.
  • 30. 05/22/10 STEP I : Primary Prevention of Rheumatic Fever (Treatment of Streptococcal Tonsillopharyngitis) Agent Dose Mode Duration Benzathine penicillin G 600 000 U for patients Intramuscular Once 27 kg (60 lb) 1 200 000 U for patients >27 kg or Penicillin V Children: 250 mg 2-3 times daily Oral 10 d (phenoxymethyl penicillin) Adolescents and adults: 500 mg 2-3 times daily For individuals allergic to penicillin Erythromycin: 20-40 mg/kg/d 2-4 times daily Oral 10 d Estolate (maximum 1 g/d or Ethylsuccinate 40 mg/kg/d 2-4 times daily Oral 10 d (maximum 1 g/d)
  • 31. Step II: Anti inflammatory treatment 05/22/10 Clinical condition Drugs
  • 32.
  • 33. 05/22/10 STEP IV : Secondary Prevention of Rheumatic Fever (Prevention of Recurrent Attacks) Agent Dose Mode Benzathine penicillin G 1 200 000 U every 4 weeks* intramuscular or Penicillin V 250 mg twice daily Oral or Sulfadiazine 0.5 g once daily for patients 27 kg (60 lb Oral 1.0 g once daily for patients >27 kg (60 lb) For individuals allergic to penicillin and sulfadiazine Erythromycin 250 mg twice daily Oral *In high-risk situations, administration every 3 weeks is justified and recommended
  • 34. 05/22/10 Duration of Secondary Rheumatic Fever Prophylaxis Category Duration Rheumatic fever with carditis and At least 10 y since last residual heart disease episode and at least until (persistent valvar disease * ) age 40 y, sometimes lifelong prophylaxis Rheumatic fever with carditis 10 y or well into adulthood, but no residual heart disease whichever is longer (no valvar disease*) Rheumatic fever without carditis 5 y or until age 21 y, whichever is longer *Clinical or echocardiographic evidence.
  • 35.