Acute Rheumatic Fever: Actually It Is A Poorly Understood
Acute Rheumatic Fever: Actually It Is A Poorly Understood
to Group A Streptococcus.
Joints, Skin and Subcutaneous Tissues, Brain, Serous surfaces and the HEART.
The disease would be of little practical consequences except for the cardiac
valve damage.
-2–
Incidence
Sporadic - 0.3 %
Epidemic - 3%
10 days - 3wks.
Etiology -3–
Pathogenesis
Average -- 18 days.
PATHOLOGY
Ventricular surface of MV
Aschoff bodies. Seen especially in the left atrium and the ventricles.
JONES CRITERIA
Pancarditis Myocarditis
Endocarditis
in Chronic Changes.
Initially Insufficiency Later Stenosis
M R - 100%
then MR + AR - 20% MS
A R alone rare AS
T R - Very rarely Not
P R - not Seen Seen
Signs of Pericarditis - 10 –
2 Gallop rhythm.
Isolated AR rare
TR & PR:
PR not seen
- 15 –
Chorea - Sydenham Chorea, St. Vitus’ Dance
CNS manifestation alone with involvement of Basal ganglia & caudate nucleus
Resolves in 1 – 2 wks
Severe cases 3 – 4 months up to 2yrs
Very rarely recurs.
Subcutaneous Nodules - 17 –
It may persist for days to month after the onset of Rh. Fever.
A S O > 333 U
Anti DNase B
AH
A 2 fold in Antibody titer more important than a single value
i. Supportive Treatment
No need to wait for the murmur to disappear, ESR & CRP to come
back to normal.
CHF: Diuretics
Digitalis
Supportive Measures
Prevention - 25 –
Primary Prophylaxis
Treatment of Streptococcal Pharyngitis to prevent a primary
attack of RF.
12 L - Benzathine Peni: IM - Single
6 L - Procaine Peni: IM - OD x 10 day.
Penicillin V - 250mg/day - BD x 10 day.
Erythromycin - 40mg /kg /day - tid / Qid x 10
Secondary Prophylaxis
Prevention of recurrence of RF
12 L – Benzathine P – IM – Every 3wks
Penicillin V - 250 mg Bid
Sulfadiazine – 500mg OD
Erythromycin – 250 mg Bid
Carditis
Rebound
Mimetic Character.
Rheumatic Chorea.