Rheumatic Fever and Rheumatic heart disease

Dr. Muhammad Imran

6/2/2015 1

Learning Outcomes

After attending this presentation the audience will be able to:

• Define Rheumatic fever

• Describe the Pathogenesis of Rheumatic fever(RF)

• Illustrate the Clinical features of RF

• Write the diagnosis of Rheumatic fever

• Devise the prevention of RF

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Rheumatic Fever

• Rheumatic fever (RF) is an acute, immunologically mediated, multisystem inflammatory disease that occurs a few weeks following an episode of group A streptococcal pharyngitis

• Major involvement of systemic connective tissue; heart, joints, skin, and subcutaneous and vascular connective tissue

Oxford Handbook of Cardiology. 2nd edition. Page:146-150 6/2/2015 3

Epidemiology

• <1:1000 in developed countries; 10:1000 schoolchildren in developing countries

• It is rarer, but still accounts for half of cardiac disease in the developing world

• Typically affects children aged 5–15 years from lower socio-economic

• No sex difference but mitral stenosis are more common in females

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Pathology

• Typically occurs several weeks after a streptococcal pharyngitis

• Usually group A beta haemolytic streptococci: Streptococcus pyogenes serotype M. Antigenic mimicry is implicated — antibodies to carbohydrate in cell wall (anti-M antibodies) of group A Streptococcus cross-react with protein in cardiac valves

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Pathology (Continue)

• Delay from acute infection to onset of rheumatic fever is usually 3–4 weeks

• RF is thought to complicate up to 3 % of untreated streptococcal sore throats

• Commonly causes a pancarditis

Oxford Handbook of Cardiology. 2nd edition. Page:146-150 6/2/2015 6

Pathogenesis

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Clinical features

• Sore throat 1–5 weeks earlier is reported in two-thirds of cases

• Fever, abdominal pain, and epistaxis • Migratory large-joint polyarthritis

starting in the lower limbs in 75 % of cases

• Pancarditis in 50 % of cases with features of acute heart failure, mitral and aortic regurgitation, an apical, and pericarditis

• Chorea in 10–30 % , usually 1–6 months after the index pharyngitis

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Clinical features (Continue)

• Erythema marginatum is an evanescent rash and central clearings on the trunk and proximal limbs

• Subcutaneous nodules in 0–8 % of cases several weeks after the onset of severe pancarditis

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Diagnosis Criteria

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Rheumatic heart disease • Rheumatic heart disease is a

complication of rheumatic fever

• Divided into rheumatic endocarditis, rheumatic myocarditis and rheumatic pericarditis, often for rheumatic pancarditis

• 60% to 80% children are associated with pancarditis

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Key morphologic

features of acute

rheumatic heart

disease

Prevention

• The only known way to prevent rheumatic fever is to treat strep. throat infections promptly with a full course of appropriate antibiotics

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Prevention (Continue)

• If you have or suspect you have rheumatic fever see your doctor or local health clinic

• If you have had rheumatic fever make sure you always have your regular penicillin injections

• Get regular check-ups at your local health clinic

• Do not ignore a sore throat. Consult your doctor

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Prevention (Continue)

• Keep sores clean and covered

• Wash hands regularly

• Watch out for symptoms in children – people aged between 5 and 14

• Eat a healthy diet

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Prevention (Continue)

Primary Prevention:

Primary prevention of rheumatic fever is possible with a 10-day course of penicillin therapy for streptococcal pharyngitis. However, primary prevention is not possible in all patients

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Secondary Prevention

Who should receive prophylaxis?

Patients with documented histories of rheumatic fever, including those with isolated

chorea and those without evidence of rheumatic heart disease, must receive prophylaxis

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Secondary Prevention (Continue)

For how long?

Ideally, patients should receive prophylaxis indefinitely. For patients who had acute rheumatic fever without carditis, the prophylaxis should continue for at least 5 years or until the person is 21 years of age

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Key message

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