Acute Rheumatic Fever

Acute Rheumatic Fever

Is a systemic disease characterized by inflammatory lesions of connective and endothelial tissue :

Acute Rheumatic Fever

Acute Rheumatic Fever

Etiology :

- The exact pathogens are unknown.

- It is thought to be an autoimmune response to group a beta hemolytic streptococci.

- Most first attacks of rheumatic fever preceded by streptococcal infection of the throat or upper respiratory tract at an interval of several days to several weeks.

Altered physiology :

- The unique pathologic lesion of rheumatic fever is the Aschoff body.

- The basic changes consist of exudative and proliferative inflammatory reactions in the mesenchymal supporting tissues of the heart, joints blood vessels and subcutaneous tissue.

- The inflammatory process involves all layers of the heart.

- The inflammatory may involve the heart valves, most frequent the mitral and/or the aortic valves.

Clinical manifestations :

- The diagnosis is based on a combination of manifestations of the disease.

- The presence of 2 major criteria or 1 major and 2 minor criteria, plus evidence of preceding streptococcal infection are required to establish the diagnosis.

Major manifestations :

1- Carditis: significant murmurs, signs of pericarditis, cardiomegaly or congestive heart failure.

2- Polyarthritis: the affected joints are swollen, tender and red migratory, the large joints are affected.

3- Subcutaneous nodules :
- Firm, painless bodies seen or felt over the extensor surface of certain joints, particularly the elbow, knee and wrists.

- Disappear mostly after 4 months.

- Presence of nodules is an indicator that the heart is involved.

4- Erythema marginatum :
Circinate or annular rash occur on the arms, trunk and legs { never on the face}. evanescent, pink rash, have pale centers and round or wavy margins.

5- Chorea : Purposeless involuntary movement often associated with muscle weakness, incoordination of voluntary movement and emotional instability.

Minor manifestations :

1- Fever.

2- Arthralgia.

3- Prolonged P-R interval in the ECG.

4- Increased E.S.R, leukocytosis, positive C-reactive protein.

5- A history of streptococcal infection, scarlet fever, previous history of rheumatic fever.

Treatment :

1- Bed rest for 2 weeks then gradual ambulation.

2- Cases without cardiac involvement, aspirin only 100 mg/kg/day in 4 hours divided doses . until E.S.R. is normal for 2 weeks.

3- With cardiac involvement aspirin and prednisone.

4- Prevention of rheumatic fever through control of streptococcal infection: procaine penicillin G 1.200.000 units once a month.



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