1 major plus 2 minor manifestations PLUS
evidence of recent strep
Possible ARF: 1 major manifestation PLUS evidence of
recent strep
Recurrent ARF: 2 major or 1 major plus 2 minor or 3
minor manifestations PLUS evidence of recent strep
No ARF: No criteria met
Management of ARF
Management of ARF
1. Treatment of acute attack:
- Bed rest
- Salicylates (Aspirin)
- Antibiotics (Penicillin) if carditis
- Corticosteroids for severe carditis
2. Secondary prophylaxis:
- Benzathine penicillin G every 4 weeks lifelong
- Or
Acute Rheumatic Fever and Rheumatic Heart Disease, are two common conditions in children between 3-15 years of age following a Group B Streptococcal throat infection. We discuss these two conditions in the slides above, as well as their management.
A mosquito-borne viral disease occurring in tropical and subtropical areas.
Those who become infected with the virus a second time are at a significantly greater risk of developing severe disease.
Symptoms include high fever, headache, rash and muscle and joint pain. In severe cases there is serious bleeding and shock, which can be life threatening.
Treatment includes fluids and pain relievers. Severe cases require hospital care.
RHEUMATIC FEVER AND RHEUMATIC HEART DISEASEANILKUMAR BR
Rheumatic heart disease (RHD) is damage to one or more heart valves that remains after an episode of acute rheumatic fever (ARF) is resolved.
It is caused by an episode or recurrent episodes of ARF, where the heart has become inflamed.
The heart valves can remain stretched and/or scarred, and normal blood flow through damaged valves is interrupted.
Untreated, RHD causes heart failure and those affected are at risk of arrhythmias, stroke, endocarditis and complications of pregnancy.
These conditions cause progressive disability, reduce quality of life and can cause premature death in young adults.
Heart surgery can manage some of these problems and prolong life but does not cure RHD.
RHD is the a chronic condition characterized by scarring and deformity of the heart valves following rheumatic fever infection.
Rheumatic fever is an inflammatory disease that may affect many connective tissues of the body, especially those of the heart, joints, brain or skin. It usually starts out as a strep throat (streptococcal) infection.
Acute Rheumatic Fever and Rheumatic Heart Disease, are two common conditions in children between 3-15 years of age following a Group B Streptococcal throat infection. We discuss these two conditions in the slides above, as well as their management.
A mosquito-borne viral disease occurring in tropical and subtropical areas.
Those who become infected with the virus a second time are at a significantly greater risk of developing severe disease.
Symptoms include high fever, headache, rash and muscle and joint pain. In severe cases there is serious bleeding and shock, which can be life threatening.
Treatment includes fluids and pain relievers. Severe cases require hospital care.
RHEUMATIC FEVER AND RHEUMATIC HEART DISEASEANILKUMAR BR
Rheumatic heart disease (RHD) is damage to one or more heart valves that remains after an episode of acute rheumatic fever (ARF) is resolved.
It is caused by an episode or recurrent episodes of ARF, where the heart has become inflamed.
The heart valves can remain stretched and/or scarred, and normal blood flow through damaged valves is interrupted.
Untreated, RHD causes heart failure and those affected are at risk of arrhythmias, stroke, endocarditis and complications of pregnancy.
These conditions cause progressive disability, reduce quality of life and can cause premature death in young adults.
Heart surgery can manage some of these problems and prolong life but does not cure RHD.
RHD is the a chronic condition characterized by scarring and deformity of the heart valves following rheumatic fever infection.
Rheumatic fever is an inflammatory disease that may affect many connective tissues of the body, especially those of the heart, joints, brain or skin. It usually starts out as a strep throat (streptococcal) infection.
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
Muktapishti is a traditional Ayurvedic preparation made from Shoditha Mukta (Purified Pearl), is believed to help regulate thyroid function and reduce symptoms of hyperthyroidism due to its cooling and balancing properties. Clinical evidence on its efficacy remains limited, necessitating further research to validate its therapeutic benefits.
Adv. biopharm. APPLICATION OF PHARMACOKINETICS : TARGETED DRUG DELIVERY SYSTEMSAkankshaAshtankar
MIP 201T & MPH 202T
ADVANCED BIOPHARMACEUTICS & PHARMACOKINETICS : UNIT 5
APPLICATION OF PHARMACOKINETICS : TARGETED DRUG DELIVERY SYSTEMS By - AKANKSHA ASHTANKAR
Best Ayurvedic medicine for Gas and IndigestionSwastikAyurveda
Here is the updated list of Top Best Ayurvedic medicine for Gas and Indigestion and those are Gas-O-Go Syp for Dyspepsia | Lavizyme Syrup for Acidity | Yumzyme Hepatoprotective Capsules etc
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
Basavarajeeyam is an important text for ayurvedic physician belonging to andhra pradehs. It is a popular compendium in various parts of our country as well as in andhra pradesh. The content of the text was presented in sanskrit and telugu language (Bilingual). One of the most famous book in ayurvedic pharmaceutics and therapeutics. This book contains 25 chapters called as prakaranas. Many rasaoushadis were explained, pioneer of dhatu druti, nadi pareeksha, mutra pareeksha etc. Belongs to the period of 15-16 century. New diseases like upadamsha, phiranga rogas are explained.
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
CDSCO and Phamacovigilance {Regulatory body in India}NEHA GUPTA
The Central Drugs Standard Control Organization (CDSCO) is India's national regulatory body for pharmaceuticals and medical devices. Operating under the Directorate General of Health Services, Ministry of Health & Family Welfare, Government of India, the CDSCO is responsible for approving new drugs, conducting clinical trials, setting standards for drugs, controlling the quality of imported drugs, and coordinating the activities of State Drug Control Organizations by providing expert advice.
Pharmacovigilance, on the other hand, is the science and activities related to the detection, assessment, understanding, and prevention of adverse effects or any other drug-related problems. The primary aim of pharmacovigilance is to ensure the safety and efficacy of medicines, thereby protecting public health.
In India, pharmacovigilance activities are monitored by the Pharmacovigilance Programme of India (PvPI), which works closely with CDSCO to collect, analyze, and act upon data regarding adverse drug reactions (ADRs). Together, they play a critical role in ensuring that the benefits of drugs outweigh their risks, maintaining high standards of patient safety, and promoting the rational use of medicines.
- Video recording of this lecture in English language: https://youtu.be/kqbnxVAZs-0
- Video recording of this lecture in Arabic language: https://youtu.be/SINlygW1Mpc
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
2. • To know about the epidemiology of ARF
• To understand the pathogenesis of ARF
• To know about the clinical features of ARF
• To learn about the diagnosis of ARF
• To understand management of ARF
• To know about the prevention of ARF
• To discuss the principles of management of
ARF
LEARNING OBJECTIVES
3. • ARF is a post infectious, non-suppurative sequel of
pharyngeal infection with Streptococcus pyogenes
• RHD is the only long-term sequel of ARF
• RHD manifests after several years of ARF with
heart failure or complications like stroke or infective
endcocarditis.
• ARF and RHD can easily be prevented by early
identification and treatment of streptococcal
pharyngeal infection.
• Currently, the 2015 AHA/ACC criteria are used to
diagnose ARF
Introduction
4. • Rheumatic heart disease currently affects over 33 million
people worldwide.
• RHD is found all over the world, but most commonly
affects women, adolescents and children living in
conditions of poverty and overcrowding.
• RHD kills 275,000 people every year, even though it is
a preventable disease.
• A few rich countries (including the USA and UK) and
some LMIC Countries like Cuba have managed to
reduce their burden of RHD, but other countries
continue to struggle with the disease.
• RHD is a lifelong condition, which is often fatal if not
treated properly.
EPIDEMIOLOGY
5. RHD in Ethiopia
• Recent school and community based studies in
Ethiopia have shown the prevalence of RHD in 4-
24 years age groups to be from 14-38/1000,which
is one highest in the world.
• Approximately 250, 000 people in the age group 5-
15 suffer from RHD in Ethiopia.
• More than 500,000 people of all age groups live
with RHD.
• Only few give history of Acute Rheumatic Fever
6. • RHD is the main cardiovascular diagnosis
accounting for 30-60% of all cardiac patients in
main hospitals of Ethiopia
• Patients usually come late with heart failure , stroke
or during pregnancy with severe valvular disease
• Mortality from RHD may reach 12.5% every year in
rural Ethiopia.
• It is also reported that 70% of RHD patients die before
the age of 26 years.
RHD in Ethiopia…
7. Risk Factors for Rheumatic Fever
• Socioeconomic status:
– Poverty
– Poorly made and overcrowded housing
– Lack of adequate health care
– Untreated GAS infections
• Sex
• Rheumatic fever occurs in equal numbers in males and females,
but the prognosis is worse for females than for males.
• Age
– Rheumatic fever principally affects children between 5-15
years of age with a median age of 10 years, although it also
occurs in adults (20% of cases).
• Risk factor for RHD
– Recurrent ARF
8. Risk factors for Rheumatic Fever
Determinants Effects Impact on ARF and RHD
burden
Socioeconomic &
environmental factors
1. Poverty
2. Poor nutrition
3. Overcrowding
4. Poor standard of living
1. Rapid spread of
GABHS
2. Difficulties accessing
health care
1. Higher incidence of acute strep
pharyngitis and complications
2. Higher incidence of ARF and
recurrent ARF
Health System Related Factors
1. Shortage of resources for
health care
2. Low level of knowledge of
disease among health care
providers
3. Low level of awareness of
disease in the community
1. Inadequate diagnosis
and treatment of strep
pharyngitis
2. Misdiagnosis or late
diagnosis of ARF
3. Inadequate secondary
prophylaxis delivery
1. Higher incidence of ARF and
recurrent ARF
2. Missed first ARF episode
3. Inadequate secondary prophylaxis
delivery
4. Higher rates of recurrent ARF with
more frequent and severe heart valve
involvement
5. Higher rates of repeated hospital
admissions and expensive heart
valve surgery
9. • Rheumatic fever is thought to result from an
inflammatory autoimmune response with antibodies
produced against streptococcal antigen induces
inflammation in host tissue having similar molecules
(ANTIGEN MIMICKERY THEORY)
• Only group A beta-hemolytic streptococcal infections
of the pharynx initiate or reactivate rheumatic fever.
• In 0.3-3% of streptococcal pharyngeal infection,
rheumatic fever develops several weeks after the sore
throat has resolved.
• Studies show the existence of genetic predisposition in
addition to bacterial factors.
Etiology and Pathogenesis
10. Etiology and Pathogenesis…
• After recovery from the initial episode of RF, up
to 60% to 65% of patients develop valvular heart
disease and the risk of RF recurrence following
GAS infection rises to 50%.
• Repeated GAS infections without appropriate
treatment (with benzathine penicillin G) leads to
RF recurrences and progressive valve damage-the
defining characteristic of RHD which can, in turn,
cause atrial fibrillation, heart failure, stroke and
endocarditis.
14. Clinical Features
• Following sore throat with GABHS:
– Silent period of 2 - 6 weeks
– Sudden onset of fever, pallor, malaise, fatigue
• After which characteristic manifestations rheumatic fever
start to appear:
– Arthritis
– Carditis
– Erythema marginatum
– Subcutaneous nodules
– Sydenham’s chorea
• In one third of patients the streptococcal infection passes
unnoticed and 54 to 70% of recurrences of ARF were
caused by asymptomatic streptococcal infection.
16. 1. Arthritis
• It occurs in about 75% of cases.
• Usually a polyarthritis involving big joints: knees,
ankles, elbows, wrists
• Asymmetrical
• Migratory (fleeting)
• Joints are hot, red, tender, swollen with limited
mobility
• It is unusual to involve the central joints as spines,
hips and the peripheral ones as the fingers and toes.
Infrequently it involves the tempromandibular
joint.
17. Arthritis…
• No residual deformity (licks)
• It is more common and more severe in
teenagers and young adults than in children
• Lasts 2-6 weeks
• Dramatic response to salicylates
18. 2. Carditis
• Occurs in 40% of patients during the first attack
and almost 100% if ARF recurs.
• It may be the only major manifestations and
usually appears in the first week of the illness.
• Most serious manifestation
• May lead to death in acute phase or at later stage
• Any cardiac tissue may be affected
• Valvular lesion most common: mitral and aortic
• Seldom see isolated pericarditis or myocarditis
19. Pancarditis is the most serious and second most
common complication of rheumatic fever (50%).
In advanced cases, patients may complain of
dyspnea, mild-to-moderate chest discomfort,
pleuritic chest pain, edema, cough, or orthopnea if
they develop congestive heart failure and
pericarditis.
Upon physical examination, carditis is most
commonly detected by a new murmur and
tachycardia out of proportion to fever.
The murmurs of acute rheumatic fever are
typically due to valve insufficiency.
Carditis….
20. Carditis..
• Clinical signs:
High pulse rate
Murmurs : Mitral and aortic regurgitation most
common
Pericarditis usually asymptomatic
Occasionally causes chest pain, friction rubs or distant
heart sounds
Cardiomegaly
Rhythm disturbances (prolonged PR interval)
Heart failure
22. 3. Sydenham’s Chorea(10-20%)
• Due to basal ganglia involvement.
• May be associated with normal laboratory findings.
• Involuntary, sudden, semi-purposeful movements of
limbs face and tongue. Disappear during sleep.
• Hypotonia and hyporeflexia.
• Emotional labiality and instability.
• More in females.
• Latent period (2-6 months). No arthritis and ESR is
usually normal.
• Self-limiting.
24. 4. Subcutaneous Nodule
– Small, painless, firm, free.
– Accumulated Aschoff nodules.
– Over bony prominences,
tendons .
– Often associated with severe
carditis.
– Can occur with other diseases
like rheumatoid arthritis
– They last for a week or two and
rarely more than a month, and
sometimes disappear within
several days.
25. 5. Erythemia Marginatum (10%)
– Erythema with central pallor.
– More on trunk and proximal
limbs.
– It usually occurs in the covered
parts and may be manifested by
local application of heat.
– Nonpruritic, nonpainful.
– Often associated with acute
carditis.
– They disappear within hours and
may appear intermittently within
weeks to months
27. Laboratory findings in ARF
1. Elevated acute phase reactants
1. Erythrocyte sedimentation rate(>30mm/hr)
2. Leukocytosis
3. C-reactive protein
2. Recent Evidence of Group A Streptococcal infection :
– Raised ASO titer (80% of cases)
– Anti DNAase B
– Antihyaluronidase
– Rapid Stretococcal antigen test.
– Positive throat culture for (GAS),
– Recent scarlet fever
3. Increased PR interval on EKG (first degree heart block )
28. Imaging
• Cardiomegaly and signs of Heart failure on
Chest x-ray
• 2D and Doppler Echocardiography
– To identify and assess severity of carditis
29. Diagnosis of ARF
• No specific diagnostic test for ARF
• Diagnosis is based on 2015 AHA/ACC with
constellation of major and minor
manifestations used as diagnostic criteria
• For diagnosis of ARF the evidence of recent
streptoccal infection should be demonstrated in
addition to the criteria.
30. Revised Jone’s Criteria for Diagnosis of ARF
(2015 ACC/AHA )
Evidence of preceding group A streptococcal infection (other than chorea):
Raised ASO titer ,OR
Positive throat culture for GABH,OR
Positive Rapid antigen test, OR
Clinical evidence of bacterial Tonsilo-pharyngitis
Diagnosis : Initial ARF 2 major or 1 major plus 2 minor manifestations PLUS evidence of
recent strep infection (other than chorea)
Recurrent ARF
2 major or 1 major and 2 minor or 3 minor PLUS evidence of
recent strep infection(other than chorea)
Criteria
A. Major B. Minor
Arthritis (Monoarthritis or
polyarthritis or polyarthralgia)a
Monoarthralgia
Carditisb (Clinical and/or subclinical) Fever (≥38°C)
Chorea ESR ≥30 mm/h and/or CRP ≥3 mg/dLc
Erythema marginatum Prolonged PR on ECG (for age) (unless carditis is a
major criterion
Subcutaneous nodules
31. Diagnostic Classes of New ARF
Definite ARF: 2 major, or 1 major plus 2 minor
manifestations PLUS evidence of recent strep
infection (other than chorea)
Highly Probable ARF: If an ARF diagnosis is
considered highly probable (but not confirmed due to
lack of evidence for recent streptococcal infection)
Uncertain ARF: in patients from high-risk groups
with only one major manifestation of acute Rheumatic
fever or borderline echocardiographic findings .
32. Treatment for ARF
• Admission to hospital
–Admit all patients suspected to have ARF
• Confirmation of the diagnosis:
–Observation prior to anti-inflammatory
treatment: paracetamol may be given for
fever or joint pain
–Investigations: CBC,ESR,CXR,ECG,
Echocardiography
33. Treatment for ARF…
1. Treat Infection: Antibiotics: :
o A single intramuscular injection of benzathine
penicillin G (BPG) to eradicate GAS from upper
respiratory tract.
600 000 IU for those less than 7 years and
1.2 million IU for those who are 7 years of age or more.
o After this initial course of antibiotic therapy the
patient should be started on long term monthly BPG
secondary prophylaxis.
o Oral erythromycin if allergic to penicillin
34. Treatment for ARF…
2. Arthritis and fever
o Paracetamol until diagnosis is confirmed
o Mild arthralgia and fever may respond to paracetamol alone.
o Arthritis or Severe arthralgia :Aspirin, naproxen or ibuprofen once diagnosis is
confirmed, if present
Start Aspirin 75 mg per kilogram per day divided 6 hourly after meals for 4
weeks , OR
Ibuprofen 30mg/kg per day 8 hourly.
Do ESR 2 weekly, taper aspirin by decreasing the dose by 2 tablets every week
o Patients not responding or not tolerating aspirin:
start Prednisolone 2mg per kilogram per day for 2 weeks; then aspirin is added
at dose 60 mg per kilogram per day divided into 4 doses for another 2 weeks;
then Prednisolone is tapered & discontinued.
Do ESR 2 weekly, taper aspirin by decreasing the dose by 2 tablets every
week.
35. Treatment for ARF…
3. Carditis/heart failure
• Bed rest, with mobilization as symptoms permit
• Urgent echocardiography
• Management of Heart Failure:
– fluid restriction for mild or moderate failure
– Furosemide 1-2mg/kg PO per day
– ACE inhibitors for more severe failure, particularly if
AR present
– Digoxin and anticoagulants, if AF present
– Prednisolone can be given for severe carditis
– Valve surgery for life-threatening acute carditis(rare)
36. Treatment for ARF…
4. Chorea
– No treatment for most cases.
– Carbamazepine or valproic acid if treatment necessary
(for severe cases)
5. Other management considerations
– Register patient in a RHD Register
– Ask about family members: those with sore throat are
given one injection of benzathine penicillin or oral
antibiotics for 10 days.
– Educate client and family on dental care and
importance of secondary prophylaxis
37. Management of Probable ARF
A. Highly-Probable ARF: manage as for definite ARF
B. Uncertain ARF:
• Administer 12 months of secondary prophylaxis initially,
and reassess (including echocardiography) at 1 year.
• If there is no evidence of recurrent ARF, and no evidence of
cardiac valvular damage on echocardiography at 12 months,
consider ceasing secondary prophylaxis.
38. Prevention of ARF:
Depends on eradication of group A streptococci from upper respiratory tract. It is
divided into:
1. Primordial Prevention:
• Improving socioeconomic conditions, nutrition, housing conditions (decreasing
crowding) and improving access to health care can all decrease the incidence of
ARF.
2. Primary prevention:
• Prompt treatment of GAS pharyngitis with one injection of IM BPG is highly
effective in preventing first attacks of ARF.
• However, about 1/3 of patients with ARF do not recall preceding episode of
pharyngitis
• A vaccine for GAS is being developed but has not yet been used in clinical
practice
3. Secondary Prophylaxis
• Monthly injection of BPG IM to prevent recurrences of rheumatic fever
39. Forest plots of studies preventing rheumatic fever
through school and/or community projects
Source: Robertson KA et al. Antibiotics for the primary prevention of acute rheumatic fever: a
meta-analysis. BMC Cardiovasc Disord. 2005 5: 1-9
40. • Community and combined school and
community sore throat treatment interventions
could be expected to reduce the incidence of
ARF by up to 60%.
• GAS pharyngitis is droplet-spread and the rate
of GAS pharyngitis cross-infection within a
household is between 19-50%.So household
contact tracing to interrupt the spread of GAS
following a case of rheumatic fever
41. Case Study (2)
Sara is 15 year old girl who has been diagnosed as RHD 2
years ago, she presented with ankle pain for 2 days, which of
the following is true:
a. If there is leucocytosisand high ASO, she should receive
aspirin in a high dose
b. Recurrence of ARF needs to be considered only if she has
fever.
c. We need 2 major criteria to diagnose recurrence of ARF
d. If she is compliant with BPG , no need to request further
investigations
e. Ankle pain is considered a minor Jones criteria
42. Summary
• A long-term Management Plan should be established to
prevent recurrence of ARF and development or worsening of
RHD
• Probable ARF cases should also be monitored.