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Rheumatic Fever PowerPoint Presentation

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Description : This medical presentation titled "Rheumatic Fever" talks about rheumatic fever, a systemic disease in children,often recurrent that follows group A beta hemolytic streptococcal infection.

Tags : Rheumatic Fever, children, childhood, URTI, GABH streptococci, diffuse inflammatory disease, connective tissue,

Published on : Apr 26, 2021 | Views : 5721 | Downloads : 40

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Rheumatic Fever
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Dr.Said Alavi 2 Etiology Acute rheumatic fever is a systemic disease of childhood,often recurrent that follows group A beta hemolytic streptococcal infection It is a delayed non-suppurative sequelae to URTI with GABH streptococci. It is a diffuse inflammatory disease of connective tissue,primarily involving heart,blood vessels,joints, subcut.tissue and CNS
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Dr.Said Alavi 3 Epidemiology Ages 5-15 yrs are most susceptible Rare <3 yrs Girls>boys Common in 3rd world countries Environmental factors-- over crowding, poor sanitation, poverty, Incidence more during fall ,winter & early spring
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Dr.Said Alavi 4 Pathogenesis Delayed immune response to infection with group.A beta hemolytic streptococci. After a latent period of 1-3 weeks, antibody induced immunological damage occur to heart valves,joints, subcutaneous tissue & basal ganglia of brain
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05/05/1999 Dr.Said Alavi 5 Strains that produces rheumatic fever - M types l, 3, 5, 6,18 & 24 Pharyngitis- produced by GABHS can lead to- acute rheumatic fever , rheumatic heart disease & post strept. Glomerulonepritis Skin infection- produced by GABHS leads to post streptococcal glomerulo nephritis only. It will not result in Rh.Fever or carditis Group A Beta Hemolytic Streptococcus
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Dr.Said Alavi 6 Clinical Features Migratory polyarthritis, involving major joints Commonly involved joints-knee,ankle,elbow & wrist Occur in 80%,involved joints are exquisitely tender In children below 5 yrs arthritis usually mild but carditis more prominent Arthritis do not progress to chronic disease 1.Arthritis
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Dr.Said Alavi 7 Clinical Features (Contd) Manifest as pancarditis(endocarditis, myocarditis and pericarditis),occur in 40-50% of cases Carditis is the only manifestation of rheumatic fever that leaves a sequelae & permanent damage to the organ Valvulitis occur in acute phase Chronic phase- fibrosis,calcification & stenosis of heart valves. 2.Carditis
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Dr.Said Alavi 8 Clinical Features (Contd) Occur in 5-10% of cases Mainly in girls of 1-15 yrs age May appear even 6 months after the attack of rheumatic fever Clinically manifest as-clumsiness, deterioration of handwriting,emotional lability or grimacing of face 3.Sydenham Chorea
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Dr.Said Alavi 9 Clinical Features (Contd) Occur in <5%. Unique, transient lesions of 1-2 inches in size Pale center with red irregular margin More on trunks & limbs & non-itchy Worsens with application of heat Often associated with chronic carditis 4.Erythema Marginatum
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Dr.Said Alavi 10 Clinical Features (Contd) Occur in 10% Painless,pea-sized,palpable nodules Mainly over extensor surfaces of joints,spine,scapulae & scalp Associated with strong seropositivity Always associated with severe carditis 5.Subcutaneous nodules
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Dr.Said Alavi 11 Clinical Features (Contd) Other features (Minor features) Fever – Low grade Arthralgia Pallor Anorexia Loss of weight
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Dr.Said Alavi 12 Laboratory Findings High ESR Anemia, leucocytosis Elevated C-reactive protien ASO titre >200. (Peak value attained at 3 weeks,then comes down to normal by 6 weeks) Anti-DNAse B test Throat culture-GABHstreptococci
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Dr.Said Alavi 13 Laboratory Findings (Contd) ECG- prolonged PR interval Echo - valve edema,mitral regurgitation, LA & LV dilatation,pericardial effusion,decreased contractility
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Dr.Said Alavi 14 Diagnosis Rheumatic fever is mainly a clinical diagnosis No single diagnostic sign or specific laboratory test available for diagnosis Diagnosis based on MODIFIED JONES CRITERIA
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Dr.Said Alavi 15 Recommendations of the American Heart Association
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Dr.Said Alavi 16 Treatment Step I - primary prevention (eradication of streptococci) Step II - anti inflammatory treatment (aspirin,steroids) Step III- supportive management & management of complications Step IV- secondary prevention (prevention of recurrent attacks)
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Dr.Said Alavi 17 STEP I: Primary Prevention of Rheumatic Fever (Treatment of Streptococcal Tonsillopharyngitis) Agent Dose Mode Duration Benzathine penicillin G 600 000 U for patients Intramuscular Once 27 kg (60 lb) 1 200 000 U for patients >27 kg or Penicillin V Children: 250 mg 2-3 times daily Oral 10 d (phenoxymethyl penicillin) Adolescents and adults: 500 mg 2-3 times daily For individuals allergic to penicillin Erythromycin: 20-40 mg/kg/d 2-4 times daily Oral 10 d Estolate (maximum 1 g/d) or Ethylsuccinate 40 mg/kg/d 2-4 times daily Oral 10 d (maximum 1 g/d) Recommendations of American Heart Association
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Dr.Said Alavi 18 Step II: Anti inflammatory treatment Clinical condition Drugs
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Dr.Said Alavi 19 Bed rest Treatment of congestive cardiac failure: -digitalis,diuretics Treatment of chorea: -diazepam or haloperidol Rest to joints & supportive splinting 3.Step III: Supportive management & management of complications
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Dr.Said Alavi 20 STEP IV : Secondary Prevention of Rheumatic Fever (Prevention of Recurrent Attacks) Agent Dose Mode Benzathine penicillin G 1 200 000 U every 4 weeks* Intramuscular or Penicillin V 250 mg twice daily Oral or Sulfadiazine 0.5 g once daily for patients 27 kg (60 lb Oral 1.0 g once daily for patients >27 kg (60 lb) For individuals allergic to penicillin and sulfadiazine Erythromycin 250 mg twice daily Oral *In high-risk situations, administration every 3 weeks is justified and recommended Recommendations of American Heart Association
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Dr.Said Alavi 21 Prognosis Rheumatic fever can recur whenever the individual experience new GABH streptococcal infection,if not on prophylactic medicines Good prognosis for older age group & if no carditis during the initial attack Bad prognosis for younger children & those with carditis with valvar lesions