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      Rheumatic fever is an acute immune mediated multisystem disease which primarily involves heart, joint, central nervous system, skin and subcutaneous tissue occured as a delayed sequel to Pharyngeal infection with group A Beta Haemolytic streptococci.

The Streptococcus Beta Haemolyticus group A also caused Acute Glomerulonephritis but those streptococcus which have Rheumatogenic strains cause Rheumatic fever. Rheumatic serotypes are 1, 3, 6, 14, 18, 19, 24, 27, and 29.( grifith)

And those which have nephritogenic strains caused AGN. Nephrotic serotypes are 1, 4, 12, 52, 54

CAUSES

Streptococcus(strep-toe-KOK-us) beta Haemolytic group A. Infection of pharynx ( throat).

Period between pharyngeal infection and onset of rheumatic fever ranges from 1-5 weeks.

Rheumatic Fever characterised by exudative inflammatory lession of connective tissue maily involves heart, joint, skin, central nervous system.

Specific strains of group A streptococcus whic have antigens that cross react with cardiac myosin and sarcolemma membrane protein. Now Antibody produced against the streptococcal antigen cause inflammation of heart ( endocardium, myocardium, and pericardium), joints and the skin

Age – Affects the person ages in between 5 and 15 year of old

In adult it’s very rare, but adults can also get rheumatic fever.

SYMPTOMS

• SORE THROAT
• POLY ARTHRITIS –

1. early manifestation
2. Knee, shoulder, elbow, wrist joint involves
3. Pain and swelling shows in joints
4. Joints shows inflammation with or without effusion
5. No bony deformity except jaccound arthopathy

• CARDITIS

1. Early manifestation
2. Pancarditis present
3. Carey coombs murmur present due to vulvulitis, mitral vulve disfunction. It is specific diagnosis of rheumatic fever.

• SUBCUTANEOUS NODULES

1. Rare and late manifestation
2. Small painless mobile nodule seen over extensor surfaces and bony prominance
3. Generally associated with carditis

• SYDENHAM CHOREA( involuntary movement of certain muscle) OR RHEUMATIC CHOREA OR ST VITUS CHOREA/ ST VITUS DANCING (CNS)

1. Late manifestation
2. Involuntary movement of over the head, face and upper limb
3. Commonly in female

• ERYTHEMA MARGINATUM –

1. Redness of skin and mucous membranes and face never involves
2. Erythematous macules commonly seen in trunk and proximal part of Extremities
3. Non itching
4. Rare or early manifestation

• FEVER
• FATIGUE
• CHEST PAIN
• HEART MURMUR
• PAIN MIGRATING IN NATURE, ONE JOINT TO ANOTHER JOINT
• UNEXPLAINED OR ONGOING HEADACHE
• STOMACH PAIN
• NAUSEA
• VOMITING

INVESTIGATION

1. DIRECT INVESTIGATION:

• Isolation of group A beta Haemolytic streptococcus ( 1, 2, 6, 14, 18, 19, and 24)
• Polymerase Chain Test ( PCR)

1. INDIRECT INVESTIGATION:

• Blood test

1. Leucocytosis
2. Neutrophilic Leukocytosis
3. Anaemia (due to haemolysis)
4. Serology test ASO titre increase more than 200
5. Acute phrase reactance –

ESR increase

C- reactive protein increase more than 6

• Echocardiogram (ECG)

1. Prolongation of P-R interval
2. 1st and rarely 2nd degree AV block
3. T wave inversion
4. Feature of pericarditis present

• Echocardiography

1. Cardiac dilatation
2. Vulvular dysfunction seen

• Chest X-Ray

1. Cardiomegaly
2. Pulmonary congestion

JONES CRITERIA is most important for diagnosis rheumatic fever

SPECIFIC DIAGNOSIS OF RHEUMATIC FEVER

Carey coombs murmur present due to vulvulitis, mitral vulve disfunction.

FOR ACUTE ATTACK:

• A single dose of benzathine penicillin should be given on diagnosis to find out any residual streptococcus infection. If the patient is penicillin-allergic , Erythromycin can be used to relief complains

ANTI-INFLAMMATORY TREATMENT:

Anti-inflammatory treatment usually relieves the symptoms of arthritis rapidly. Such as Aspirin. Aspirin should be continued until the ESR is normal.

CORTICOSTEROID:

Doctor may also prescribe a corticosteroid to reduce inflammatory conditions. Symptoms relief rapidly more than aspirin and are indicated the cases with carditis Or severe poly arthritis. Such as Prednisolone. Prednisolone should be continued until the ESR is normal.

ANTICONVULSANT TREATMENT:

If involuntary movement become more severe

BED REST:

Strick bed rest will be recommend for a few weeks

HOW RHEUMATIC FEVER PREVENTED

• Maintain and practicing proper hygiene
• Cover your mouth when sneezing or coughing
• Wash your hand frequently
• Avoid using to any item of sick person
• Avoid sharing your any item to sick person
• Avoid contact with a person who are sick
• If you or your child has a sore throat for more than three days consult with a doctor