Acute rhematic fever

Rhematic fever is a immune medicated disease which is preceded by Group ‘A’ hemolytic streptococcus infecton of throat. Or

Rheumatic fever is an immunological disorder initiated by Group A beata hemolytic streptococcus.

Clinical feature

Children of (5-15) years present with history of sore throat 2-3 weeks before with in

1.           Fever

2.           Anorexia

3.           Chest pain

4.           Breathlessness

5.           Joint pain

6.           Lethargy

Diagnostic criteria : it has been described as jone’s criteria  2major or 1major+2minor criteria makes the diagnosis of acute rhematic fever

Major criteria

1.           Carditis

2.           Migratory polyarthritis

3.           Erythema  marginatum

4.           Subcutaneous nodules

5.           Syndentamis chorea

Minor criteria

1.           Fever

2.           Arthalgia

3.           Prevoous rhematic fever or rhematic heart disease

4.           Increase  TLC

5.           Increase ESR

6.           Increase CRP(creatine protein)

7.           Increase PI interval

Essential criteria

1.           Increase Antistreptolysin ‘o’ titer >200in adult and >300 in children

2.           Positive throat culture

3.           History of scarlet fever

Investigation

1.           Blood :increase ESR , increase total count , increase  c-protien , increase  ASO (anti streptolysin o )titer

2.           Throat swab :culture and sevsitivity

3.           ECG :evidence of carditis

4.           Echocardiography: valvula lesion , heart function

Treatment

1.           Bed rest : till acute phase reactants (ESR,CRP)

2.           Aspirin :90-120mg/kg/day in a divided dose *10wks then trpperd in the 2wks alternatively

3.           Corticosteroids is used  if inflammation is not controlled by aspirin prednosolune 1-2 mg/kg/day is used thus reduces finlamation and decreasecarditis and arthritis (maximum dose 60mg) is given 3wks than tapered gradually in nxet 9wks.

Treatment of heart failure if needed

1.       Xigoxine

2.       frusemide

4.           Antistreptococcal therapy : drug of choice is penicillin

5.           Single dose of Benzathine penicillin 0.6-1.2million   units alternatively IM once a weeks or procain penicillin 4 lakh units IM *BD or

6. penicillin  V 125-250mg orally QID*10days

7. Erythromycin 250mg QiD*10days

Prevention of rhematic fever

1.                   Primary prevention:prevent Rhematic fever by taking early antibiotic for throat infection

Penicillin 10dys or benzathin penicillin 10dys

2.                   Secondary prevention :prevents further damage of organ ie -heart , joints

Benzathin penicillin every 3-4wks 1200000 unit for >30kg

600000 unit <30kg continue long life