Rheumatic Fever

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Rheumatic Fever
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• Done by
• Waheed Al-Attas
• IyadJabakhanji
• Mohammad Basabreen

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Will Include

• Definition
• Epidemiology
• Pathogenesis
• Clinical features
• Diagnosis
• Treatment
• Complication
• Prevention

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Definition

• - Rheumatic fever is an inflammatory disease that
  may develop after an infection with  group A Beta
  Hemolytic Streptococcal (such as strep throat or
  scarlet fever). to be caused by antibody
  cross-reactivity  that can involve the heart ,
  joints, skin and brain .
• -Rheumatic fever mainly affects children ages  

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Epidemiology

• - Important cause of chronic disease and death in
  developing world
• - Estimated 30 million people suffer from ongoing
  ?
• heart disease from ARF, 70 dying at average age
• 35 years old
• - Usually occurs in people between 6 -15years old
  ?
• Males and females equally affected ?-
• - Overcrowding, poverty, lack of access to
  medical care contributes to transmission?
• - incidence with peak in colder months

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Pathogenesis

• - Group A strep pharyngeal infection precedes
• clinical manifestations of RF by 2 3 weeks
• -Antibodies made against group A strep
  cross-react ?
• with human tissue
• - heart valve and brain share common
  antigenic sequences with GAS bacteria
• - theory of molecular mimicry
• - Host immune responses may play a role in ?
• determining who gets ARF following infection
• - Virulent strains rheumatogenic serotypes

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Clinical Features

• Following upper airway infection with GAS
• Silent period of 2 - 3 weeks
• Sudden onset of fever, pallor, malaise, fatigue

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Symptoms

• Abdominal pain
• Fever
• Cardiac Problems
• Arthritis  
• Joint swelling
• Nose bleeds
• Skin nodules
• Skin rash
• chorea  

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Jones criteria

• Major
• carditis
• Poly Arthritis
• Chorea
• Subcutanous nodule
• Erythema marginatum

• Minor
• Fever
• artharlagia
• Previous history of rheumatic fever
• High ESR and C-reactive protien
• Leukocytosis
• Prolonged PR interval

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Investigations

• Conduct a thorough physical examination that
  mayinclude
• Checking the joints for signs of inflammation
• Examining the skin for nodules under the skin or
  a rash
• Listening to the heart for abnormal rhythms,
  murmurs or muffled sounds that may indicate
  inflammation of the heart
• Conducting a series of simple movement tests to
  detect indirect evidence of inflammation of the
  central nervous system

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Cont.

• CBC
• Blood test for recurrent strep infection (such as
  anAntistreptolysin O titertest)
• ECG
• ESR

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Treatment

• Antibiotics to eliminate any remaining strep
  bacteria that may exist in your child's body.
• Begin another course of antibiotics to prevent
  recurrence of rheumatic fever.
• Anti-inflammatory medications such as asprinor
  corticosteroids reduce inflammation to help
  manage acute rheumatic fever.
• Anticonvulsant medications. If the involuntary
  movements of Sydenham chorea are severe

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Complications

• Arrhythmias
• Damage to heart valves (in particular, mitral
  stenosis and aortic stenosis)
• Endocarditis
• Heart failure
• Pericarditis
• Sydenham chorea

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Prevention

• The most important way to prevent rheumatic fever
  is by getting quick treatment for strep throat
  and scarlet fever.

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References

• Bisno AL, Stevens DL. Streptococcus pyogenes. In
  Mandell GL, Bennett JE, Dolin R, eds. Principles
  and Practice of Infectious Diseases. 7th ed.
  Philadelphia, Pa Elsevier Churchill Livingstone
  2009chap 198.
• Pubmed Health

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