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Epidemiology

Department faculty and hospital therapy of medical faculty and department internal diseases of medical prophylactic faculty. Acute rheumatic fever.

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Epidemiology

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  1. Department faculty and hospital therapy of medical faculty and department internal diseases of medical prophylactic faculty. Acute rheumatic fever

  2. Acute rheumatic fever - a systemic inflammatory disease of connective tissue with a predominant localization of the process in the cardiovascular system, developing in connection with acute infection, β-hemolytic streptococcus group A, in adolescents, ages 7-15.

  3. Epidemiology In most cases, the disease begins in childhood and adolescence (7-15 years).

  4. Aetiology • β-hemolytic streptococcusgroup A Risk factors • heredity • dishormonal violation • social factors • climatic factors

  5. Pathogenesis • The development of ARF defined by direct toxic damage to the components of myocardial cardiotrophic enzymes β-hemolytic streptococcus group A is particularly attach great importance to the development of cellular and harmonal immune responses to various antigens AG streptococcus, leading to the synthesis of anti streptococcalAb cross-reacts with AG infarction (the phenomenon of "molecular mimicry" .)

  6. Patomorphology Stage 1 - mucoid swelling lasts 2 weeks.Stage 2 - fibrinoid swelling lasts 1,5-2 months.Stage 3 - the formation of Aschoff-Talalayev’sgranulomas continues 1,5-2 months.Stage 4 - fibrotic and sclerotic changes.

  7. Clinic Arthritis - a leading symptom of the disease in two thirds of patients with first attack of rheumatic fever. A characteristic feature of it is migratory in nature. Pain in the joints often leads to a substantial limitation in their mobility. Take off at the same time there is swelling of joints, and sometimes redness of the skin over them.

  8. Clinic (continuation) Rheumatic heart disease - clinical carditis is defined by myocarditis, endocarditis, or pericarditis. Signs of endocarditis: expanding the boundaries of the heart, the appearance of cardiac noise, disturbance of heart rhythm. Signs of pericarditis: expanding the boundaries of cardiac dullness, muted tones, noise, friction pericardium. Signs of myocarditis: tachycardia, conduction disturbances and AV block (on ECG).

  9. Clinic (continuation) Annular erythema- pink, not itchy rash is localized on the inner surface of the body extremities and neck. Subcutaneous nodules rheumatic - smaller formations localized periarticular tissues at sites of attachment of tendons over bony prominences at the joints.

  10. Clinic (continuation) Chorea - involuntary jerking of the limbs chaotic and mimic muscles, accompanied by violation of the handwriting, slurred speech and clumsiness.

  11. Diagnostic criteria of rheumatic fever (Kissel-Johns Nesterov) 1. The main criteria1.1 carditis1.2 polyarthritis1.3 chorea 1.4 rheumatic nodules, 1.5 annular erythema

  12. 2. Additional criteria: A. General: 2.1 improving the temperature2.2 weakness, fatigue, irritability2.3 pale skin2.4 sweating2.5 epistaxis2.6 abdominal syndrome

  13. B. Special (laboratory values​​) • leucocytosis (neutrophil) • dysproteinemia, increased ESR, • abnormal serum blood parameters: increased ASO titers, ASA, ASG. • increased capillary permeability.

  14. Working classification of Rheumatic fever (Association of Rheumatologists RUSSIA, 2001)

  15. Working classification of Rheumatic fever (Association of Rheumatologists RUSSIA, 2001) (continued)

  16. Classification and nomenclature of Acute rheumatic fever (APP, 2003)

  17. Differential diagnosis Carditis: 1. infectious-allergic myocarditis2. functional cardiopathy4. bacterial endocarditis5. cardiomyopathy6. thyrotoxic myocardial

  18. Differential diagnosis (continuation) Arthritis: • 1. reactive arthritis • 2. rheumatoid arthritis • 3. Bechterew's disease • 4. arthritis in hemorrhagic vasculitis Carditis + arthritis: • 1. SLE • 2. MICs • 3. rheumatoid arthritis

  19. Treatment 1-phase - stationary.2-step - in the clinic under the supervision of cardiorheumatologist3-step - Spa.

  20. Prophylaxis Primary - rehabilitation of chronic foci of infection, hardening of the body. Secondary - bicillin -3 bicillin -5 extentcillin.

  21. Forecast • Prognosis is determined by the efficiency of treatment of rheumatic heart disease, the presence of valvular and their influence on hemodynamics.

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