A short ppt on rheumatic fever

1. Rheumatic Fever

2.  Acute Rheumatic Fever(ARF) is a
multisystem disease resulting from
an autoimmune reaction to infection
with group A streptococcus.
 It usually affects children between
the 5 and 15 years and rarely in
persons above 30 years.

3. Pathogenesis
 The condition is triggered by an immune
mediated delayed response to infection with
specific strains of group A streptococci, which
have antigens that may cross react with cardiac
myosin and sarcolemmal membrane protein.
 The antibodies produced against the
streptococcal antigens cause inflammation in
the endocardium, myocardium and pericardium.

4. Clinical Features
It usually presents with fever, anorexia ,lethargy and
joint pain .
occurs 2-3 weeks after an episode of streptococcal
pharyngitis.
Other features include Skin rashes, carditis and
neurologial changes.

5. Joint Involvement
Most common feature occurs in 80% of patients
involving major joints.
Commonly involved joints knee, hips,ankle, shoulders,
elbow & wrist
Involved joints becomes red,swollen tender and the
pain is usually disabling until anti inflammatory drugs
are started.
The typical arthritis is migratory , moving from one joint
to another over a period of hours.

6. Carditis
 Manifest as pancarditis(endocarditis, myocarditis and
pericarditis),occurs in 40-50% of cases
 Carditis is the only manifestation of rheumatic fever
that leaves a permanent damage to an organ
 Chronic phase- fibrosis, calcification & stenosis of
heart valves
 Mitral valve is almost always affected sometimes
along with the aortic valve . Early valvular damage
leads to regurgitaton .
 Myocardial inflammation can cause P-R interval
prolongation and softening of first heart sound.
c
Carditis

7. Skin Manifestations
 Erythema Marginatum occurs in less than 5% of the
patients.
 The lesions start as red macules that fade in the
centre but remain red at the edges .
 THEY occur mainly in the trunk and the proximal
extremeties and not the face.
 Subcutaneous nodules occur in 5-7% of patients .
 They are small, painless and firm over the extensor
surfaces of bone or tendons.
 They occur 3 weeks after the onset of other
manifestations.
ERYTHEMA MARGINATUM

8. Sydenham’s Chorea
 It is a late neurologial manifestation that appears at least 3 months after
the episode of acute rheumatic fever.
 More commonly seen in females .
 Charectirized by purposeless , involuntary movements of the hands , feet
or face .
 Usually restricted to one side of the body.
 Resolves usually within 6 weeks .

9. Jones Criteria
 They are guidelines decided to help clinically diagnose rheumatic fever.
 Two major criteria or one major and two minor plus a history of a
streptococcal throat infection are required to make the diagnosis of
rheumatic fever.

10. *

11. Treatment
 ANTIBIOTICS : All patients with ARF should receive antibiotics to treat the
precipitating group A streptococcal infection.
 Pencillin is the drug of choice and can be given orally as phenoxymethyl
pencillin 500 mg daily for 10 days or Single dose of 1.2 million units IM
benzathine Pencillin G.
 NSAIDS: Used for the teatment of arthritis , arthralgia once the diagnosis is
confirmed.
 CORTICOSTEROIDS: Prednisolone(1-2mg/kg/day in divided doses)
should be continued until ESR is normal and then tapered off.
 DIAZEPAM OR HALOPERIDOL can be administered for chorea.
 Bed rest is essential during this period.