0 Rheumatic Fever

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Rheumatic Fever

Organism : Group A beta haemolytic Streptococci

Most frequent --> 5 - 15 years ( it is rare in <5years)
Latent period - 3 wks
After 3 wks - Autoimmune phenomenon - Therefore give Asprin , Steroids.

Modified Jones Criteria for diagnosis :

Major Criteria :

  1. Migratory Polyarthritis (MC) (75-80%) - no residual deformity
  2. Carditis (50-60%)
  3. SubCutaneous Nodules
  4. Erythema Marginatum
  5. Chorea (late)

Minor Criteria:

Clinical
  • Fever
  • Arthralgia
Laboratory
  • Acute phase reactants: Leukocytosis, elevated eritrosedimentation rate (ESR) and C-reactive protein (CRP)
  • Prolonged P-R interval on electrocardiogram (ECG)


Essential Creteria : Past history of streptococcal infection
  • Culture throat 
  • Increased ASO titre
  • Positive Antigen test

MC lesion in heart valve is MR (Mitral Regurgitation),
Later with Rheumatic heart disease - its MS (Mitral Stenosis)

Note: 

  • AS (Aort. Stenosis) is never seen.
  • Aschoff's nodule on Post mortem biopsy.
  • If Chores - then its RF even without other criterias being fulfilled
  • During recurrences - Only joint pain.


Treatment :

  1. Complete rest till all Acute phase reactants subside
  2. Asprin or Steroids for 12 wks

Primary prevention Not possible

Secondary Prevention

  • High risk patients
  • Give Benzathine Penicillin - 1.2 MU / IM every 3 wks 
  • Ideally for life long or Minimum till 35 years / 5yrs from last attack.
  • If lesion in heart - give Inf. Endocarditis prophylaxis




MedicoNotebook - Founder : DrShiviMudgal , Co-Founder : DrAyushGoel

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