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Rheumatic fever

Rheumatic fever. Group a steptococcal URTI. AGE . PEAK AGE -5-15 YRS IN INDIA UPTO 45 YRS MANIFESTATIONS -2 ND -3 RD –DECADE OF LIFE. PREVALENCE. SEEN IN LOWER SOCIO ECONOMIC CLASS SEEN IN OVER CROWDED LIVING PLACES FAMILY CLUSTERINGS

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Rheumatic fever

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  1. Rheumatic fever Group a steptococcal URTI

  2. AGE • PEAK AGE -5-15 YRS • IN INDIA UPTO 45 YRS • MANIFESTATIONS -2ND -3 RD –DECADE OF LIFE

  3. PREVALENCE • SEEN IN LOWER SOCIO ECONOMIC CLASS • SEEN IN OVER CROWDED LIVING PLACES • FAMILY CLUSTERINGS • 3 % OF UNTREATED INDIVIDUALS PROGRESS TO HAVE RHEUMATIC FEVER • RHEUMATOGENIC STRAINS-5,6,18 • ISOLATED STRAINS-GR A BETA HAEMOLITIC STRAINS

  4. PATHOGENESIS • DIRECT INFECTION OF GROUP A STREPTOCOCCUS • TOXIC EFFECTS OF STREPTOCOCCAL PRODUCTS ON HEART TISSUES • ABNORMAL /DYSFUNCTIONAL IMMUNE RESPONSE

  5. STREPTOLYSIN O ANTGEN • ANTIGEN MIMICRY • SIMILARITY B/W-GROUP SPECIFIC CARBOHYDRATE OF GR A STREPTOCOCCAL GLYCOPROTEIN OF HEART VALVES • STREPTOCOCAL M PROTEIN SIMILAR TO SARCOLEMMAL OF MYOCARDIAL CELL

  6. DIAGNOSIS –JONES CRITERIA • 2 MAJOR OR 1 MAJOR AND 2 MINOR CRITERIA • MAJOR CRITERIA • CARDITIS • MIGRATORY POLY ARTHRITIS • SYDENHAMS CHOREA • ERYTHEMA MARGINATA • SUBCUTANEOUS NODULES

  7. MINOR CRITERIA • FEVER /ARTHRALGIA • ELEVATED ACUTE PHAGE REACTANTS • PROLONGED PR INTERVAL • PLUS • THROAT C/S –POSITIVE G R A BETA HEMOLYTIC STREPTOCOCCI • INCREASED ASLO

  8. CARDITIS • PANCARDITIS –PERI/MYO/ENDO CARDITIS • SINUS TACHY CARDIA • MITRAL REGURGITATION • S3 GALLOP • PERICARDIAL RUB • CARDIOMEGALY • FIBROSIS –THICKENING AND ADHESIONS-VALVULAR HEART DISEASE

  9. MIGRATORY POLY ARTHRITIS • 75 % MAJOR JOINTS –ANKLE ,WRIST,KNEE,ELBOW, • SALICYLATES

  10. SYDENHAMS CHOREA –ST VITUS DANCE • SUBCUTANEOUS NODULES –EXTENSOR SURFACES • ERYTHEMA MARGINATUM-EFFERVACENT MACULAR ERUPTIONS

  11. DIGNOSIS • ASLO • ANTI DEOXY RIBOSE NUCLEASE B • ANTI HYALURONIDASE

  12. TREATMENT • ANTI STREPYTOCOCCAL TREATMENT • CLINICAL MANIFESTATION • 10 DAYS –PENNICILLIN ORAL -500 BID • ERYTHROMYSIN250-4 TIMES DAILY • IM BENZATHINE PENNICILLIN G-1.2 M UNITS ONCE IN 3 WKS-10 YRS • ESP IN RHD

  13. ARTHRITIS SALICYLATES -2 G • ESR –TO MONITOR ONCE IN 2 WKS • CARDITIS –GLUCOCORTICOIDES –PREDNISOLONE 30MGS 4-6 WKS • TILL ACUTE PHASE REACTANTS ARE RETURNED TO NORMAL

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