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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