Ravilya_Pediatrics_ Reumatic Fever

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acute rheumatic fever,

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acute rheumatic fever, a multisystem inflammatory disease. The disease occurs among children 5 to 15 years of age with a peak incidence
at 8 years and is rarely seen in children younger than 2 years of age.

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RF/etiology

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pathogenesis of reumatic fever

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The pathogenesis of rheumatic fever is thought to be secondary
to an immune response to antigens in the M protein of the capsule of the group A beta-hemolytic streptococcus, which occurs in susceptible hosts and cross-reacts with similar epitopes in human joint tissue,
heart, and brain tissue.

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pathological finding

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Pathologic findings include inflammatory lesions that include perivascular
granulomas consisting of infiltrates of cells and fibrin that are also known as Aschoff bodies

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incidence
onset of disease

. The typical course includes pharyngitis with improvement of symptoms.
when the patient begins to develop a low-grade fever and the inflammatory response of rheumatic fever.

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incidence of acute rheumatic fever is approximately 0.3-3% in untreated patients with Streptococcus pyogenes pharyngitis. The onset of disease occurs 1-5 weeks later with a mean of 18 days following the onset of pharyngitis. The typical course includes pharyngitis with improvement of symptoms. Two weeks later the patient begins to develop a low-grade fever and the inflammatory response of rheumatic fever.

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Major criteria

. The most common manifestation is polyarthritis occurring in up to 70% of patients

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Major criteria include polyarthritis, carditis, erythema marginatum, subcutaneous
nodules, and chorea. The most common manifestation is polyarthritis occurring in up to 70% of patients, typically a migratory arthritis involving the large joints (knees, hips, ankles, elbows), which characteristically responds dramatically to salicylate therapy.

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Carditis occurs in approximately 50% of cases and includes

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Carditis occurs in approximately 50% of cases and includes myocarditis, pericardial effusions,
arrhythmias, and valvular heart disease

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reumatic fever and skin

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Erythema
marginatum (Figure 4-1) occurs in less than 10% of patients and is a nonpruritic serpiginous rash that occurs on the torso and is almost never seen on the face. The rash is evanescent and becomes more apparent following hot baths or being wrapped in warm blankets. Subcutaneous nodules are nontender,
freely mobile nodules occurring usually over the bony surfaces of the elbows, wrists, shins, knees, ankles, and spine. They occur in 2-10% of cases.

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neuropsychiatric problms in reumatic fever

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Chorea occurs in up to 15% of cases and is a neuropsychiatric
disorder that may include choreiform movements, hypotonia, emotional lability, anxiety, and an obsessive-compulsive disorder. Chorea usually
occurs late, after the initial pharyngitis with the average time to onset of about 6-7 months. It may last as long as 18 months. Recent evidence suggests that chorea is associated with the presence of antineuronal
antibodies

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pathological finding

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Pathologic findings include inflammatory lesions that include perivascular
granulomas consisting of infiltrates of cells and fibrin that are also known as Aschoff bodies

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incidence
onset of disease

. The typical course includes pharyngitis with improvement of symptoms.
when the patient begins to develop a low-grade fever and the inflammatory response of rheumatic fever.

Back 12

incidence of acute rheumatic fever is approximately 0.3-3% in untreated patients with Streptococcus pyogenes pharyngitis. The onset of disease occurs 1-5 weeks later with a mean of 18 days following the onset of pharyngitis. The typical course includes pharyngitis with improvement of symptoms. Two weeks later the patient begins to develop a low-grade fever and the inflammatory response of rheumatic fever.

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Major criteria

. The most common manifestation is polyarthritis occurring in up to 70% of patients

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Major criteria include polyarthritis, carditis, erythema marginatum, subcutaneous
nodules, and chorea. The most common manifestation is polyarthritis occurring in up to 70% of patients, typically a migratory arthritis involving the large joints (knees, hips, ankles, elbows), which characteristically responds dramatically to salicylate therapy.

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Carditis occurs in approximately 50% of cases and includes

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Carditis occurs in approximately 50% of cases and includes myocarditis, pericardial effusions,
arrhythmias, and valvular heart disease

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reumatic fever and skin

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Erythema
marginatum (Figure 4-1) occurs in less than 10% of patients and is a nonpruritic serpiginous rash that occurs on the torso and is almost never seen on the face. The rash is evanescent and becomes more apparent following hot baths or being wrapped in warm blankets. Subcutaneous nodules are nontender,
freely mobile nodules occurring usually over the bony surfaces of the elbows, wrists, shins, knees, ankles, and spine. They occur in 2-10% of cases.

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neuropsychiatric
disorder in reumatic fever

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Chorea occurs in up to 15% of cases and is a neuropsychiatric
disorder that may include choreiform movements, hypotonia, emotional lability, anxiety, and an obsessive-compulsive disorder. Chorea usually
occurs late, after the initial pharyngitis with the average time to onset of about 6-7 months. It may last as long as 18 months. Recent evidence suggests that chorea is associated with the presence of antineuronal
antibodies.

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Minor manifestations

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Minor manifestations include fever, arthralgias (when polyarthritis is not present), increased acute phase reactants such as CRP, and a prolonged PR interval on ECG (in the absence of other evidence of carditis).

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when we diagnose the reum fever

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if artritis is one of presenting symptoms, what about artalgia

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tx and complication

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The diagnosis of acute rheumatic fever is made with

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The diagnosis of acute rheumatic fever is made with either 2 major manifestations
or with a single major manifestation and 2minor manifestations. If made by 1 major manifestation
and 2 minors, the diagnosis should be supported
by evidence of a preceding streptococcal infection either by a positive throat culture or by rising streptococcal antibody titers (eg, antistreptolysin
0).

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There are 3 exceptions to the Jones criteria
for diagnosis of acute rheumatic fever:

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1.
Chorea may be the only manifestation of rheumatic
fever.
2.
Indolent carditis may be the only manifestation in patients following the initial infection.
3.
Recurrences often do not strictly fulfill the Jones criteria. Therefore, a presumptive diagnosis of recurrent rheumatic fever may be made with fewer than the usual number of criteria.

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Recurrent
disease should only be diagnosed if there is

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Recurrent
disease should only be diagnosed if there is supporting evidence of a recent streptococcal infection

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Treatment for acute rheumatic fever includes therapy

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Treatment for acute rheumatic fever includes therapy directed at the streptococcal infection with penicillin followed by prevention of recurrences with either twice-daily oral penicillin or once monthly
1M benzathine penicillin injections. Although some advocate prophylaxis to be continued
at least until the patient is 21 years of age, others recommend that prophylaxis be lifelong

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In patients who are penicillin allergic,

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In patients who are penicillin allergic, prophylaxis can be substituted
with either oral sulfadiazine or erythromycin

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valve is the most commonly affected

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The mitral valve is the most commonly affected followed by the aortic valve and, rarely, the tricuspid or pulmonary valves. Initially, the affected valves develop regurgitation as a result of inflammation and valve dysfunction. However, with healing of the inflammation, long-term development of mitral valve stenosis can occur