What is rheumatic fever?
Rheumatic fever is a delayed consequence of an untreated upper respiratory infection with group A streptococci (streptococcal pharyngitis or "strep throat"). The disease can cause serious, debilitating damage to the heart and involve other tissues.

Who gets rheumatic fever?
A small percentage, probably less than 0.3 percent, of all people who have streptococcal pharyngitis will develop acute rheumatic fever.

What are the symptoms of rheumatic fever?
Initially, rheumatic fever is acute. The major symptoms of rheumatic fever are: carditis, polyarthritis, chorea, subcutaneous nodules, and a rash called erythema marginatum.

Carditis is the most significant manifestation of rheumatic fever because it may cause permanent organ damage or death. Carditis is frequently mild or asymptomatic and therefore difficult to detect. Although not fully understood, a person's immune system response to a streptococcal infection appears to cause tissue degeneration, most frequently heart valve tissue, and subsequently, cardiac disability or death.

Polyarthritis is arthritis in a number of joints at a time. Chorea is a neurologic syndrome that may appear after a latent period of several months. Chorea is seen as rapid, purposeless, involuntary movements in the extremities and the face. Subcutaneous nodules are firm, painless lesions that occur over bony surfaces just under the skin. Erythema marginatum is a rash that appears mostly on the trunk and extremities.

How soon after exposure do symptoms appear?
The peak age of incidence for rheumatic fever is 5 to 15 years, but cases do occur in adults. Acute rheumatic fever is rare in children less than 4 years of age.

There is a latent period of 1 to 5 weeks (average 19 days) between streptococcal pharyngitis and the initial episode of acute rheumatic fever. The average duration of an attack of acute rheumatic fever is 3 months or longer. After the acute attack has subsided, many people are left with damaged heart valves (rheumatic heart disease). Some people will have recurrent acute attacks of rheumatic fever, frequently causing more damage to the heart valves.

How is it diagnosed?
May be difficult to diagnose. There are no specific laboratory tests to diagnose acute rheumatic fever. In general, rheumatic fever can be diagnosed with documentation of a recent infection with group A streptococcal infection and observation of one or more of the major symptoms (described above).

What is the treatment for rheumatic fever?
Antibiotics will not modify an acute rheumatic fever attack nor affect the subsequent development of carditis. However, a recommended regimen of antibiotics prescribed for treatment of streptococcal pharyngitis is recommended to eradicate any group A streptococci remaining in the patient, and in part, to prevent spread of the organism to close contacts.

What precautions should the person take who has had rheumatic fever?
Those people who have already suffered a rheumatic fever attack are extremely susceptible to a recurrence if they are again infected with group A streptococci. Patients who have experienced a documented acute rheumatic fever attack should receive continuous antibiotic prophylaxis to prevent streptococcal infections at least until reaching adulthood or at least 5 years after their most recent attack. Patients whose acute rheumatic fever attack has left them with damaged heart tissue may need lifelong antibiotic prophylaxis. Invasive dental or surgical procedures may require additional antibiotic prophylaxis for patients with rheumatic valvular heart disease.

How can rheumatic fever be prevented?
Prevention of rheumatic fever involves prompt, accurate diagnosis and effective treatment of streptococcal pharyngitis especially in school-aged children and others who live in crowded conditions such as the military and large households.

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thnx for these valuable data abt rheumatic fever.. but what Abt ASO titre in the diagnosis of it?
thnx in advance

aso titre as we all know is the anti streptolysin antibody thet is found in our body and remain in the body as cic and if detected in the body gives positive diagnosis for the pre strep disease.

A rheumatic fever can be cause by a Strep throat infection which has not been treated for about two to three months, It is rare to get rheumatic fever, but if your have a strep infection an over the counter cold medicine will help to prevent it. Read all lables before you take a medicne, because it may interfere with any medications you are taking for any preexisiting conditions. if symptoms persist, you should consalt a doctor.


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[quote=gebal;44906]A rheumatic fever can be cause by a Strep throat infection which has not been treated for about two to three months, It is rare to get rheumatic fever, but if your have a strep infection an over the counter cold medicine will help to prevent it. Read all lables before you take a medicne, because it may interfere with any medications you are taking for any preexisiting conditions. if symptoms persist, you should consalt a doctor.

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vt is the most common that is observed if u get RF after strep infec.... tell me among this.. carditis.arthralgia,erythema marginatum,subcutaneous nodules

Answer: Arthritis

Several major and minor criteria have been developed to help standardize rheumatic fever diagnosis. Meeting these criteria, as well as having evidence of a recent streptococcal infection, can help confirm that you have rheumatic fever.

The major diagnostic criteria include:


Arthritis in several joints (polyarthritis)

Heart inflammation (carditis)

Nodules under the skin (subcutaneous skin nodules)

Skin rash (erythema marginatum)

Rapid, jerky movements (chorea, Sydenham's chorea)



The minor criteria include fever, joint pain, high ESR, and other laboratory findings.

You'll likely be diagnosed with rheumatic fever if you meet two major criteria, or one major and two minor criteria, and signs that you've had a previous strep infection.


Major criteria

The mnemonic JONES is often used to recall the Major Criteria.

Joints (Migratory polyarthritis): a temporary migrating inflammation of the large joints, usually starting in the legs and migrating upwards.

O [imagine heart-shaped O] (carditis): inflammation of the heart muscle which can manifest as congestive heart failure with shortness of breath, pericarditis with a rub, or a new heart murmur.


Nodules (subcutaneous nodules - a form of Aschoff bodies): painless, firm collections of collagen fibers on the back of the wrist, the outside elbow, and the front of the knees. These now occur infrequently.

Erythema marginatum: a long lasting rash that begins on the trunk or arms as macules and spreads outward to form a snakelike ring while clearing in the middle. This rash never starts on the face and is made worse with heat.

Sydenham's chorea (St. Vitus' dance): a characteristic series of rapid movements without purpose of the face and arms. This can occur very late in the disease.

Clinical Features

There is a latent period of ~3 weeks (1–5 weeks) between the precipitating group A streptococcal infection and the appearance of the clinical features of ARF. The exceptions are chorea and indolent carditis, which may follow prolonged latent periods lasting up to 6 months. Although many patients report a prior sore throat, the preceding group A streptococcal infection is commonly subclinical; in these cases it can only be confirmed using streptococcal antibody testing. The most common clinical presentation of ARF is polyarthritis and fever. Polyarthritis is present in 60–75% of cases and carditis in 50–60%. The prevalence of chorea in ARF varies substantially between populations, ranging from <2% to 30%. Erythema marginatum and subcutaneous nodules are now rare, being found in <5% of cases.

Joint Involvement

To qualify as a major manifestation, joint involvement in ARF must be arthritic, i.e., objective evidence of inflammation, with hot, swollen, red and/or tender joints and involvement of more than one joint (i.e., polyarthritis). The typical arthritis is migratory, moving from one joint to another over a period of hours. ARF almost always affects the large joints—most commonly the knees, ankles, hips, and elbows—and is asymmetric. The pain is severe and usually disabling until anti-inflammatory medication is commenced.

Reference:

Harrison's Online > 17 e
Chapter 315. Acute Rheumatic Fever

Thanks for the info trimurtulu!