Rheumatic Fever

Posted by e-Medical PPT
Acute rheumatic fever is a systemic disease of childhood,often recurrent that follows group A beta hemolytic streptococcal infection
It is a delayed non-suppurative sequelae to URTI with GABH streptococci.
It is a diffuse inflammatory disease of connective tissue,primarily involving heart,blood vessels,joints, subcut.tissue and CNS

Clinical Features
Migratory polyarthritis, involving major joints
Commonly involved joints-knee,ankle,elbow & wrist
Occur in 80%,involved joints are exquisitely tender
In children below 5 yrs arthritis usually mild but carditis more prominent
Arthritis do not progress to chronic disease

Manifest as pancarditis(endocarditis, myocarditis and pericarditis),occur in  40-50% of cases
Carditis is the only manifestation of rheumatic fever that leaves a sequelae & permanent damage to the organ
Valvulitis occur in acute phase
Chronic phase- fibrosis,calcification & stenosis of heart valves.

3.Sydenham Chorea
Occur in 5-10% of cases
Mainly in girls of 1-15 yrs age
May appear even 6 months after the attack of rheumatic fever
Clinically manifest as-clumsiness, deterioration of handwriting,emotional lability or grimacing of face

4.Erythema Marginatum
Occur in <5%.
Unique, transient lesions of 1-2 inches in size
Pale center with red irregular margin
More on trunks & limbs & non-itchy
Worsens with application of heat
Often associated with chronic carditis

5.Subcutaneous nodules
Occur in 10%
Painless,pea-sized,palpable nodules
Mainly over extensor surfaces of joints,spine,scapulae & scalp
Associated with strong seropositivity
Always associated with severe carditis...

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