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

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MedicoNotebook - Founder : DrShiviMudgal , Co-Founder : DrAyushGoel