Rheumatic Fever. Collagen vascular disease with inflammation involving many organs mainly heart, brain, joints and skin. The acute form of the disease follow infection with gp A β hemolytic streptococcus of the tonsillo -pharynx ( only ) with a latent period 2-4 wks.
Collagen vascular disease with inflammation involving many organs mainly heart, brain, joints and skin. The acute form of the disease follow infection with gp A β hemolytic streptococcus of the tonsillo-pharynx (only) with a latent period 2-4 wks.
The importance of Rf is its ability to cause fibrosis of the cardiac valves, leading to a devastating hemodynamic heart diseases and regarded as the most common cause of heart disease in childhood and young adults world wide.
Incidence : • developed Countries decreased ,housing ,medical care • developing countries still high incidence(1/ 1000) • age :6-15 yrs • Affected population: militaries ,school contacts, m=f • Climate: worm tropical • A β hemolytic streptococcus M strain epitopes shared with human heart ,myocin ,sarcolemal tissue • Attack rate:3% in risky people
Symptoms: 1/3 mild sore throat 60% no history The problem is recurrence 50% vs. 3% Familiar clustering ,genetics ,HLA,
Pathology: Fibrinoid degeneration fragmentation all organs involved collagen edema infiltration,mononuclear histiocyte heart(IVS) aschoff cells hyaline degeneration fibrosis calcification
Diagnosis • There is no single specific clinical ,lab or test .Duckett jones criteria: • Major criteria: • Carditis • arthritis • Chorea • Erythema marginatum • Subcutaneous nodule • Minor criteria: • 1-clinical finding : arthritis • Fever • 2-Lab investigation : raised acute phase reactant • CRP,ESR • prolong PR interval • Previous signs of streptococcal infection .Raised ASOT • .Throat culture
Arthritis Migratory, large , multi, asymmetrical, Inflammatory, salicylate responsive ,benign remain for 2-3wk Prevalence 70% ,
SydenhamChorea St.vitus dance, chorea minor Involuntary, purposeless, uncoordinated movement with weakness& emotional liability. basal ganglia, caudate nucleus About 20%,a later manifestation(3 months vs 3 wks) During awake ,hand writing , remain for 1-2 wks For the future neuro psychosis, obsession ,recurrence
ErythemaMarginatum Evanescent, erythematous, macular rash ,pale center , rounded edge, on the trunk and extremities sparing the face . More rare 5%, More clear by applying heat
Subcutaneous nodule Fine , painless ,freely mobile,nodule,0.5-2cm,on the extensor surface of joints occipital &spinal process Rare 3%, often associated with carditis
Minor criteria • Fever and joint pain are non specific , for support diagnosis if had single major criteria. • Lab investigation: • acute phase reactant raised early, • normal in chorea • ECG prolong PR interval
Previous signs of streptococcal infection: ASOT Throat culture
Treatment(RASSA) Rest Salicylate Steroid Antibiotics: Primary prevention Secondary prevention