rheumatic fever

RHEUMATIC FEVER

PREVALENCE

There is a marked decline in the prevalence.

- Improved standards of living

- Literacy rate

- Medical facilities

- Penicillin : Treat streptococcal infections

INCIDENCE IN INDIA

• The reported incidence of RF in India varies from 0.42 – 10.9 per 1000.

• Rheumatic heart disease (RHD): 0.56 – 11 per 1000.

• Recent studies using echocardiography show a incidence of RHD : 0.12 – 0.67 per 1000.

DEFINITION

Rheumatic fever is a poorly understood inflammatory disease that occurs after infection with Group A : β- hemolytic streptococcal pharyngitis.

It is a self- limited illness that involves the joints, skin, brain, serous surfaces and heart.

ETIOPATHOGENESIS

Systemic disease

Affects connective tissue

Can occur after an untreated Group A : β- hemolytic streptococcal pharyngeal infection. Develops after 2 to 6 weeks post infection

PATHOPHYSIOLOGY

Group A Streptococcus Pyogens

Cell wall consist of M- Protein Highly antigenic

Antibody is generated against M protein

Antibody react with cardiac myofiber protein, smooth muscles

Causes release of cytokine

Leading to tissue destruction

DIAGNOSTIC EVLUATION

DIAGNOSIS

• Diagnosis follow a set of guidelines : Given by Dr. T Ducklet Jones in 1944, revised by AHA in 1965, latest revised by WHO in 2003.

• Modified Jones Criteria : Two major manifestation or one major and two minor.

INVESTIGATION

Increased level of antibodies against streptococci.

Positive throat culture for Group A streptococcus

Recent scarlet fever.

CLINICAL FEATURES :

MAJOR CRITERIA MINOR CRITERIA

Carditis Chorea Erythema

marginatum Polyarthritis Subcutaneous

nodules

Arthralgia Previous RF or

RHD Fever Elevated ESR Increased CRP Prolonged PR

interval on ECG

CHEST RADIOGRAPH OF AN 8 YEAR OLD PATIENT WITH ACUTE CARDITIS BEFORE TREATMENT

SAME PATIENT AFTER 4 WEEKS

SUBCUTANEOUS NODULE ON THE EXTENSOR SURFACE OF ELBOW OF A PATIENT WITH ACUTE RF

ERYTHEMA MARGINATUM ON THE TRUNK, SHOWING ERYTHEMATOUS LESIONS WITH PALE CENTERS AND ROUNDED OR SERPIGINOUS

MARGINS

CLOSER VIEW OF ERYTHEMA MARGINATUM IN THE SAME PATIENT

TREATMENT

No specific treatment. Management is symptomatic.

1. Bed rest- It is advised in all patients with carditis till

activity subsides.- Immobilization may have to be continued for

2–3 months.2. Diet

- Salt restriction- easily digestible nutritious diet- vitamin supplements

3. Antimicrobial Therapy- Penicillin :4L units I/M BD * 10 days.- Benzathine penicillin- Erythromycin : 20-30 mg/kg BD

4. Suppressive Therapy- Aspirin- Steroids

5. Management of Chorea- Complete physical and mental rest- Phenobarbitone : 3-5gm/kg/day-Chlorpromazine, diazepam, haloperidol provides sedation

GOAL OF MEDICAL MANAGEMENT

Eradication of hemolytic streptococci.

Prevention of permanent cardiac damage.

Palliation of other symptoms.

Prevention of recurrence of rheumatic fever.

OBJECTIVES OF NURSING MANAGEMENT

Encourage compliance with drug regimens.

Facilitate recovery from illness.

Provide emotional support.

Prevent the disease.

THANK YOU