2. PREVALENCE
There is a marked decline in the prevalence.
- Improved standards of living
- Literacy rate
- Medical facilities
- Penicillin : Treat streptococcal infections
3. 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.
4. 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.
6. PATHOPHYSIOLOGY
Group A Streptococcus Pyogens
Cell wall consist of M- Protein
antigenic
Highly
Antibody is generated against M protein
Antibody react with cardiac myofiber protein,
smooth muscles
Causes release of cytokine
Leading to tissue destruction
8. 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.
9. INVESTIGATION
Increased level of antibodies against
streptococci.
Positive throat culture for Group A
streptococcus
Recent scarlet fever.
10. CLINICAL FEATURES :
MAJOR CRITERIA
Carditis
Chorea
Erythema marginatum
Polyarthritis
Subcutaneous
nodules
MINOR CRITERIA
Arthralgia
Previous RF or RHD
Fever
Elevated ESR
Increased CRP
Prolonged PR interval
on ECG
11. CHEST RADIOGRAPH OF AN 8 YEAR OLD PATIENT
WITH ACUTE CARDITIS
BEFORE TREATMENT
17. 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
19. GOAL OF MEDICAL MANAGEMENT
Eradication of hemolytic streptococci.
Prevention of permanent cardiac damage.
Palliation of other symptoms.
Prevention of recurrence of rheumatic
fever.