Rheumatic fever

Streptococcal infection of URT
1. M antigens react with T cell and stimulate B cell to produce auto antibodies
  1. Recurrent infection of Heart muscles
    1. Myocardium - aschoff noduels ~ fibrinoid degenration + lymphocytes & Plasma cells ;
      1. Tachycardia, s3 & s4, CHF
    2. Endocardium - valvulitis, damaged chordae tendinae, regurgitations - MaTP
      1. Mid diastolic murmur (carey coombs),
      2. valve thickening, scarring, calcification and stenosis
        Pansystolic murmur
    3. Pericardium - effusion; bread and butter appearance
      1. pain, friction rub
  2. other Manifestations
    1. Joints
      1. Large Joint inflammation
        Migratory
    2. Syndenham's Chorea
      1. characteristic movements of limbs, head and tongue
        Manifests late and relsoves in 6 weeks
    3. Subcutaneous nodules
      1. In severe carditis; Over bony prominences
        resolves in 2 weeks
    4. Erythema marginatum
      1. Pink rashes: Clear centre and serpiginous margins
Investigations
1. Blood
  1. ESR
  2. CRP
  3. Antistreptolysin O, Anti DNAse B
2. Throoat Swab Culture
3. Chest X-ray
4. ECG
REVISED JONES CRITERIA 2 Major/ 1 Major+2 minor / 5 minors
1. Major
  1. Carditis
  2. Polyarthirtis
    1. Major criteria: 2 or more jts, high stretocococcal antibody titre
  3. Chorea
  4. Erythema marginatum
  5. Subcutaneous nodules
2. Minor
  1. Fever
  2. Arthralgia
  3. Prev RHD
  4. CRP and ESR raised
  5. ECG: Prolonged PR
Treatment
1. Bed rest
2. Antibiotics
  1. Benzathine penicillin 1.2m units
  2. Procaine penicillin 6L units
  3. Sensitive cases - Erythromycin 20- 40mg/kg
3. Arthritis
  1. Aspirin 60mg-8g
4. CHF
  1. Prednisolone
5. Chorea
  1. Calm environment, Valproic acid, Immunoglobulins
6. Prophylaxis:
  1. Secondary
    1. 1.2m units Benzathine penicillin, Oral penicillin 500mg, Amoxycillin 1g/day, azithromycin 500mg/day
      1. No carditis
        For 5 yr or till 18yr age
      2. resolved carditis
        For 10yr or till 25yrs age
      3. severe carditis
        Life long prophylaxis; surgery
  2. Primary
    1. Benzathine penicillin, procaine penicillin, Erythromycin

Nächster

Rheumatic fever

Beschreibung

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