Zusammenfassung der Ressource
rheumatic fever
- now rare in developed world
- but most important cause of heart disease in kids worldwide
- incidence highest in those from socially & economically disadv areas
- due to improved sanitation, use of Abx, changes in strep virulence
- caused by group A beta-haem strep
- in vulnerable ppl there is abnormal immune response to prior infection w/ this pathogen
- mainly
affects
kids
5-15
years
- clinical features
- pharyngeal infection
- fb latent interval of 2-6 weeks
- then
- polyarthritis
- malaise
- fever
- Jones criteria for diag
- to make diag
- 2 major or 1major +2 minor
- + supportive evidence of preceding group A strep
- sig raised ASO titre/other strep antibodies
- group A strep on throat culture
- major manifestations
- pancarditis (50%)
- endocarditis
- significant murmur
- valvular dysfunc
- myocarditis
- may -> heart failure & death
- pericarditis
- pericardial friction rub
- pericardial effusion
- tamponade
- polyarthritis (80%)
- ankles,
knees,
wrists
- exquisite
tenderness,
moderate
redness &
swelling
- flitting,
lasting < 1
week in a
joint
- but moves to other
joints over 1-2
months
- sydenham chorea (10%)
- 2-6 months
after strep
infection
- involuntary
movements &
emotional
lability for 3-6
months
- erythema marginatum (<5%)
- early manifestation
- trunks & limbs
- pink macular rash spreading outwards->
- pink border w/ fading centre
- borders can unite to give map-like outline
- subcutaneous nodules
- rare
- painless, pea-sized, hard
- on extensor surfaces
- minor manifestations
- fever
- polyarthralgia
- raised acute phase reactants
- CRP
- ESR
- leucocytes
- prolonged PR interval on ECG
- chronic rheumatic heart disease
- mitral
stenosis
- commonest form of
longterm damage
from scarring &
fibrosis of valve
- mitral valve
most freq
affected
- sx don't develop till early adult life
- but if repeated attacks of rheumatic fever w/ carditis
- can occur in 20s (age)
- other valves can be affected
- pulmonary valve
- most rarely
- aortic
- tricuspid
- severity of valvular disease related to no of childhood episodes of rheumatic fever
- Mx
- acute episode
- bed rest & anti-inflamm agents
- if evidence of active mycarditis
- echo changes
- raised ESR
- bed rest & limitation of exercise are essential
- acute ep: aspirin
- effective at suppressing inflammatory response of joints & heart
- high doses needed
- monitor serum levels
- acute ep:
symptomatic
heart failure
- diuretics
- ACEIs
- acute ep:
pericardiocentesis
- for sig pericardial effusions
- acute
ep:antistrep Abx
- if any evidence of persisting infection
- e.g. penicillin V for 10 days
- after acute ep resolves
- aim: prevent recurrence
- prophylaxis
- monthly benzathine penicillin injections
- most effective
- oral penicillin
- compliance issues
- if penicillin sensitive
- erythromycin
- length of Rx debatable
- most recommend treatment to age of 18 or 21 yrs
- more recently lifelong prophylaxis recommended