Presentation is loading. Please wait.

Presentation is loading. Please wait.

Rheumatic Heart Disease Rheumatic fever (RF) and rheumatic heart disease (RHD) cannot be separated from an epidemiological point of view. Rheumatic fever:

Similar presentations


Presentation on theme: "Rheumatic Heart Disease Rheumatic fever (RF) and rheumatic heart disease (RHD) cannot be separated from an epidemiological point of view. Rheumatic fever:"— Presentation transcript:

1 Rheumatic Heart Disease Rheumatic fever (RF) and rheumatic heart disease (RHD) cannot be separated from an epidemiological point of view. Rheumatic fever: is a febrile disease affecting connective tissues particularly in the heart and joints initiated by infection of the throat by group A beta hemolytic streptococci.

2 Although RF is not a communicable disease, it results from communicable disease (streptococcal pharyngitis). * RHD is one of the most readily preventable chronic non-communicable diseases.

3 * RF often leads to RHD, which is a crippling disease with many consequences such as the following: - Continuing damage to the heart. - Increasing disabilities. - Repeated hospitalization. - In addition, premature deaths usually around 35 years

4 Size of the problem: * RF and RHD present a problem in all parts of the world, especially in the developing countries. * The reported prevalence rate in school-age children in various parts of the world ranges from 1 as very low to 33 cases per 1 000\ year.

5 * Throughout the world, RF is the most common cause of heart diseases in the age group of 5-30 years, It causes about one third of deaths from heart diseases. * The great decrease in incidence of RHD and RF in most developed countries occurred before the advent of antibiotics. (????)

6 Epidemiological Factors: I- Agent factors: A- Agent: The onset of RF is usually preceded by a streptococcal sore throat. Among streptococci, group A, is the causative factor in RF, even not all group A, but certain "rheumatogenic potential" (serotype is M type 5). All group A streptococci are sensitive to penicillin. Recently, the virus (Coxsackie's B-4) has been suggested as a causative factor and streptococcus acting as a conditioning factor.

7 Epidemiological Factors: I- Agent factors: B- Carriers: Carriers of group A streptococci are very frequent, including convalescents, transient and chronic carriers. Theoretically, it is impossible to eradicate them.

8 Epidemiological Factors: II- Host and environmental factors: A- Age: RF is typically a disease of young 5-15 years. B- Sex: Both sexes are affected equally. C- Immunity: The toxic-immunological hypothesis (certain products of group A streptococci act as an antigenic cross-relationship with host tissues). D- Socio-economic status: It is a disease of poor, overcrowded people with poor housing conditions and inadequate health services (social disease).

9 Clinical Features: Fever: May stays for even 12 weeks or longer with sweating. Polyarthritis: 90 % of cases, with large joints affection with no residual damage. Carditis: 60-70 % and involves all layers of the heart, leading to tachycardia, cardiac murmurs, cardiac enlargement, pericarditis, and heart failure (ECG finding is the first-degree AV block).

10

11

12

13 Clinical Features: Nodules: 4 weeks after the onset of RF, small, non- tender, below skin, and painless with no residual damage after disappearance. Brain involvement: As abnormal, jerky, purposeless movements of arms, legs and body, and disappear without any sequels. Skin: Different rashes. * All clinical manifestations disappear without any permanent damage except carditis.

14

15 Diagnosis: The WHO Expert Committee in 1988 has recommended the use of the "revised" Jones criteria for the diagnosis of RF. The presence of two major or one major and two minors manifestations plus evidence of preceding streptococcal infection indicates a high probability of RF.

16 Revised Jones criteria: Major Minor Carditis Clinical: Fever Polyarthritis Arthralgia Chorea Previous history RF or RHD Erythema marginatum Laboratory: Abnormal ESR Subcutaneous nodules C-reactive protein Leukocytosis Prolonged P-R

17 WHO also recommended the following tests as mandatory to over-diagnose of RF: Positive throat culture for group A streptococci, and Demonstration of anti-streptococcal antibodies e.g. antistreptolysin O (ASO) or other antibodies.

18 Prevention: I- Primary prevention: The aim here is to prevent the first attack of RF, by identifying all patient with throat streptococcal infection and treating them with penicillin.

19 II- Secondary prevention: The aim here is to prevent the recurrence of RF, by identifying those who have had RF and giving them 600 000 units of benzathine penicillin for child and 1 200 000 units for adults at 3 weeks intervals for 5 years or until the child reaches the age of 18 years. This secondary prevention is feasible, inexpensive and cost-effective when implemented through PHC.

20 III- Non-medical measures: By improving living conditions. VI- Evaluation: 6-16 years, periodic surveys, random samples are the best indicators at 5 years intervals; the recommended sample depends on the prevalence.


Download ppt "Rheumatic Heart Disease Rheumatic fever (RF) and rheumatic heart disease (RHD) cannot be separated from an epidemiological point of view. Rheumatic fever:"

Similar presentations


Ads by Google