2. Learning Outcomes
After attending this presentation the audience
will be able to:
• Define Rheumatic fever
• Describe the Pathogenesis of Rheumatic
fever(RF)
• Illustrate the Clinical features of RF
• Write the diagnosis of Rheumatic fever
• Devise the prevention of RF
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3. Rheumatic Fever
• Rheumatic fever (RF) is an acute,
immunologically mediated,
multisystem inflammatory disease
that occurs a few weeks following an
episode of group A streptococcal
pharyngitis
• Major involvement of systemic
connective tissue; heart, joints, skin,
and subcutaneous and vascular
connective tissue
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4. Epidemiology
• <1:1000 in developed countries; 10:1000
schoolchildren in developing countries
• It is rarer, but still accounts for half of cardiac
disease in the developing world
• Typically affects children aged 5–15 years
from lower socio-economic
• No sex difference but mitral stenosis are
more common in females
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5. Pathology
• Typically occurs several weeks after
a streptococcal pharyngitis
• Usually group A beta haemolytic
streptococci: Streptococcus
pyogenes serotype M. Antigenic
mimicry is implicated — antibodies
to carbohydrate in cell wall (anti-M
antibodies) of group A
Streptococcus cross-react with
protein in cardiac valves
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6. Pathology (Continue)
• Delay from acute infection to
onset of rheumatic fever is
usually 3–4 weeks
• RF is thought to complicate up to
3 % of untreated streptococcal
sore throats
• Commonly causes a pancarditis
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8. Clinical features
• Sore throat 1–5 weeks earlier is
reported in two-thirds of cases
• Fever, abdominal pain, and epistaxis
• Migratory large-joint polyarthritis
starting in the lower limbs in 75 % of
cases
• Pancarditis in 50 % of cases with
features of acute heart failure, mitral
and aortic regurgitation, an apical,
and pericarditis
• Chorea in 10–30 % , usually 1–6
months after the index pharyngitis
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9. Clinical features (Continue)
• Erythema marginatum is an
evanescent rash and central
clearings on the trunk and
proximal limbs
• Subcutaneous nodules in 0–8 %
of cases several weeks after the
onset of severe pancarditis
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11. Rheumatic heart disease
• Rheumatic heart disease is a
complication of rheumatic
fever
• Divided into rheumatic
endocarditis, rheumatic
myocarditis and rheumatic
pericarditis, often for
rheumatic pancarditis
• 60% to 80% children are
associated with pancarditis
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13. Prevention
• The only known way to
prevent rheumatic fever
is to treat strep. throat
infections promptly with
a full course of
appropriate antibiotics
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14. Prevention (Continue)
• If you have or suspect you have
rheumatic fever see your doctor or local
health clinic
• If you have had rheumatic fever make
sure you always have your
regular penicillin injections
• Get regular check-ups at your local health
clinic
• Do not ignore a sore throat. Consult your
doctor
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15. Prevention (Continue)
• Keep sores clean and
covered
• Wash hands regularly
• Watch out for
symptoms in children –
people aged between 5
and 14
• Eat a healthy diet
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16. Prevention (Continue)
Primary Prevention:
Primary prevention of
rheumatic fever is possible
with a 10-day course of
penicillin therapy for
streptococcal pharyngitis.
However, primary prevention
is not possible in all patients
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17. Secondary Prevention
Who should receive prophylaxis?
Patients with documented histories
of rheumatic fever, including those
with isolated
chorea and those without evidence
of rheumatic heart disease, must
receive prophylaxis
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18. Secondary Prevention (Continue)
For how long?
Ideally, patients should receive
prophylaxis indefinitely. For
patients who had acute
rheumatic fever without
carditis, the prophylaxis should
continue for at least 5 years or
until the person is 21 years of
age
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