1 / 16

ACUTE RHEUMATIC FEVER

By:Dawit Ayele. ACUTE RHEUMATIC FEVER. Definition. Rheumatic fever is an inflammatory disease that occurs as a delayed, non- suppurative sequela of upper respiratory infection with group A streptococci. Etiology. Antecedent infection with specific microorganism- Gp A streptococci

amelie
Download Presentation

ACUTE RHEUMATIC FEVER

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. By:DawitAyele ACUTE RHEUMATIC FEVER

  2. Definition • Rheumatic fever is an inflammatory disease that occurs as a delayed, non-suppurativesequela of upper respiratory infection with group A streptococci.

  3. Etiology • Antecedent infection with specific microorganism- Gp A streptococci • At specific site- upper respiratory tract-nowhereelse • Heavily encapsulated, as evidenced by their growth as mucoid colonies on blood agar plates. • Predominant strains 3, 5, 18, 24, and others

  4. Epidemiology • 3% of individuals with untreated gp A streptococci will develop RF. • Most often occurs in children; the peak age-related incidence is b/n 5 and 15 years. • Risk factors for outbreak: -lower standards of living esp.crowding, -the organism itself -the degree of host/herd immunity to the prevalent M-types in an affected community

  5. Pathogenesis • Study Hypothesis of ‘antigenic mimicry’: 1)Similarity between the group-specific CHO of the gp A streptococcus & the glycoprotein of heart valves, -2)the molecular similarity among the streptococcal cell membrane, strept M ptnsarcolemma,& other moieties of human myocardial cell. • Possiblity of predisposing genetic influencedifferences in immune response to strept

  6. Clinical feature -- most notably affect the heart, joints, skin, subcutaneous tissue, and central nervous system. POSSIBLE FEATURES • High fever, prostration, crippling polyarthritis • Lassitude, tachycardia, new cardiac murmurs • Acute pericarditis • Fulminant heart failure • Sydenham's chorea without fever or toxicity • Acute abdominal pain mimicking appendicitis • Varying combinations of the above

  7. Diagnosis • No specific test to establish Dx • *Clinical+supportive evidence from microbiology & clinical immunology lab • 1944 Jones proposed standard criteria • 1992 updated Jones published by AHA • To fullfill the dx requires either 2 major or 1 major & 2 minor + evidence of antecedent streptococcal infection

  8. The Jones Criteria Major • Carditis • Migratory polyarthritis • Sydenham’s chorea • Subcutaneous nodules • Erythemamarginatum + Supporting evidence of a recent gp A strept infection(throat culture or rapid antigen /ab test ASO-80%+) Minor • Clinical-fever -arthralgia • Lab-↑acute phase reactants- (↑ ESR) -prolonged PR

  9. Carditis • 40-60% of RF cases have evidence of carditis • Pancarditis involve- pericardium, myocardium& endocardium • Cx-sinus tachycardia, -murmur of MR -S3 gallop -pericardial friction rub -cardiomegaly 20%-subtle mitral valve abnormality w/o audible murmur(echo dx)

  10. Carditis… • Commonly affected valves: -Mitral(pure ms or ms/mr) -Aortic-isolated is rare-mitral valve is almost always simultaneously affected -tricuspid & pulmonic –not commonly affected

  11. Migratory Polyarthritis • In as many as 75% of cases • Extremely painful joint pain & swelling • Most often affects-ankles, wrists,knees& elbows • Not usually affected-small joints of hands or feet;seldom involves hip joints

  12. Sydenham’s chorea • CNS d/o • <10% of patients • It may happen in as long as several months from initial strept infection

  13. Subcutaneous nodules & erythemamarginatum • Uncommon manifestations • Nodules found over extensor surface of joints • Are seen most often in patients with long standing Rheumatic heart dis. • EM usually concentrated on the trunk as evanescent macular eruption with rounded borders

  14. Treatment Two necessary therapeutic approach to ARF pts 1)Anti –Strept antibiotic treatment:for all patients with ARF whether culture is +/- Conventional-10 days course of oral penicillin v 5oo mg po bid or erythromycin for penicillin allergy Choise of many-Benz. Penicillin G 1.2 mill IU 2)Treatment for clinical manifestation of the disease-arthritis-ASA upto 2 gm qid -CHF –conventional medical measures -Chorea-reassurance for most-resolves in 6wks to 6 mths

  15. 2o prophylaxis • AHA recommendations- Benzanthine penicillin 1.2 million IU IM Q 4 weeks or for oral penicillin V(250mg 2x/day)or oral sulfadiazine 1 gm daily. • For those with higher risk Benz. Penicillin q 3 wks is more effective in decreasing risk of recurrence. • Risk of recurrence is highest during the 1st 5 yrs after attack—2ry prophylaxis is always given for at least these period. • Continued rx for high risk exposure gp-students,teachers,medical& military personnel. • Many believe documented recurrences &/or documented RVD should receive 20px for life!!

  16. THANK YOU

More Related