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 :
- Migratory Polyarthritis (MC) (75-80%) - no residual deformity
- Carditis (50-60%)
- SubCutaneous Nodules
- Erythema Marginatum
- Chorea (late)
- 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)
- 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.
- Complete rest till all Acute phase reactants subside
- Asprin or Steroids for 12 wks
Primary prevention Not possible
- 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
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