Rheumatic Fever
description
Transcript of Rheumatic Fever
RHEUMATIC FEVER
Collagen vascular disease with inflammation involving many organs mainly heart, brain, joints and skin.
The acute form of the disease follow infection with gp A β hemolytic streptococcus of the tonsillo-pharynx (only) with a latent period 2-4 wks.
The importance of Rf is its ability to cause fibrosis of the cardiac valves, leading to a devastating hemodynamic heart diseasesand regarded as the most common cause of heart disease in childhood and young adults world wide.
Incidence :• developed Countries decreased ,housing ,medical care• developing countries still high incidence(1/ 1000) age :6-15 yrsAffected population: militaries ,school contacts, m=fClimate: worm tropicalA β hemolytic streptococcus M strain epitopes shared with human heart ,myocin ,sarcolemal tissueAttack rate:3% in risky people
Symptoms: 1/3 mild sore throat 60% no historyThe problem is recurrence 50% vs. 3%Familiar clustering ,genetics ,HLA,
Pathology:
Fibrinoid degeneration
fragmentation all organs involvedcollagen
edema
infiltration,mononuclear histiocyte heart(IVS) aschoff cells
hyaline degeneration fibrosis calcification
Diagnosis There is no single specific clinical ,lab or test .Duckett jones criteria:
Major criteria:1. Carditis2. arthritis 3. Chorea4. Erythema marginatum5. Subcutaneous nodule Minor criteria: 1-clinical finding : arthritis Fever2-Lab investigation : raised acute phase reactant
CRP,ESR prolong PR intervalPrevious signs of streptococcal infection .Raised ASOT .Throat
culture
CARDITISPAN, PREVALENCE ~ 50%,MR ,ARTHE HALLMARK OF ARF
ArthritisMigratory, large , multi, asymmetrical, Inflammatory, salicylate responsive ,benignremain for 2-3wkPrevalence 70% ,
Sydenham ChoreaSt.vitus dance, chorea minorInvoluntary, purposeless, uncoordinated movement with weakness& emotional liability.basal ganglia, caudate nucleusAbout 20%,a later manifestation(3 months vs 3 wks)During awake ,hand writing , remain for 1-2 wksFor the future neuro psychosis, obsession ,recurrence
Erythema MarginatumEvanescent, erythematous, macular rash ,pale center , rounded edge, on the trunk and extremities sparing the face . More rare 5%,More clear by applying heat
Subcutaneous nodule
Fine , painless ,freely mobile,nodule,0.5-2cm,on the extensor surface of joints occipital &spinal processRare 3%, often associated with carditis
Minor criteriaFever and joint pain are non specific , for support diagnosis if had single major criteria.Lab investigation:• acute phase reactant raised early, normal in chorea• ECG prolong PR interval
Previous signs of streptococcal infection:ASOTThroat culture
Treatment(RASSA) RestSalicylate SteroidAntibiotics: Primary prevention Secondary prevention