rheumatic fever
DESCRIPTION
presentationTRANSCRIPT
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RHEUMATIC FEVER
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PREVALENCE
There is a marked decline in the prevalence.
- Improved standards of living
- Literacy rate
- Medical facilities
- Penicillin : Treat streptococcal infections
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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.
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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.
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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
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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
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DIAGNOSTIC EVLUATION
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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.
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INVESTIGATION
Increased level of antibodies against streptococci.
Positive throat culture for Group A streptococcus
Recent scarlet fever.
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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
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CHEST RADIOGRAPH OF AN 8 YEAR OLD PATIENT WITH ACUTE CARDITIS BEFORE TREATMENT
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SAME PATIENT AFTER 4 WEEKS
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SUBCUTANEOUS NODULE ON THE EXTENSOR SURFACE OF ELBOW OF A PATIENT WITH ACUTE RF
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ERYTHEMA MARGINATUM ON THE TRUNK, SHOWING ERYTHEMATOUS LESIONS WITH PALE CENTERS AND ROUNDED OR SERPIGINOUS
MARGINS
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CLOSER VIEW OF ERYTHEMA MARGINATUM IN THE SAME PATIENT
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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
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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
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GOAL OF MEDICAL MANAGEMENT
Eradication of hemolytic streptococci.
Prevention of permanent cardiac damage.
Palliation of other symptoms.
Prevention of recurrence of rheumatic fever.
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OBJECTIVES OF NURSING MANAGEMENT
Encourage compliance with drug regimens.
Facilitate recovery from illness.
Provide emotional support.
Prevent the disease.
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THANK YOU