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Acute Rheumatic Fever

Dr. M. S. Prasad

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Acute Rheumatic Fever

• Occurs in 5 – 15 years of age-group.

• More common in children from poor socio-economic background.

• Most likely an immunological response resulting in damage to the heart by antibodies.

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Aetiology

Untreated streptococcal sore-throat

Latent Period (10 d – several weeks)

Production of antibody during latent period

Antigen-Antibody Reaction

Rheumatic Fever

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Aetiology

Group-A beta haemolytic streptococcus

Infection of the throat

Antibody production against streptococcal antigen

Damage to Heart

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Etiology

• A history of preceding sore-throat.

• > 50% children with rheumatic fever do not have a definite history of sore-throat.

• The antibodies formed against streptococcal antigens have the capacity of react with human connective tissue especially the cardiac muscles.

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Aetiology

Antigen-Antibody Reaction

Connective Tissue

1. Arthritis2. Fever etc.

Heart Muscles

1. Carditis2. Damage to valves.

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Incidence• ARF following URI = 0.5 – 3%.

• RHD: 25-50% of all cardiac admissions in India.

• Middle East, India, Pakistan, Bangladesh, Nepal, Africa and South America.

• 20 million new cases every year.

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Sore-Throat

Appropriate Antibiotics

Worldwide decline of Rheumatic Fever

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Sex

• Female:–Chorea,– Tight Mitral Stenosis (MS).

• Male–Aortic Regurgitation (AR).

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Clinical Features

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Most common:Fever,Migratory Joint Pains

Another subset:FeverTachycardiaTachypneaPalpitation

Carditis:CHFNew murmur

Pericarditis.

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Treatment• Activity,

• Diet,

• Penicillin

• Suppressive Therapy

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Management of Chorea

• Self-limiting.

• Haloperidol,

• Complete physical and mental rest.

• Adequate sedation.

• Corticosteroid.

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Long Term Prevention

• Benzathine Penicillin,

• Penicillin-V

• Azithromycin.

• Erythromycin.