Rheumatic fever Group a steptococcal URTI

AGE PEAK AGE YRS IN INDIA UPTO 45 YRS MANIFESTATIONS -2 ND -3 RD –DECADE OF LIFE

PREVALENCE SEEN IN LOWER SOCIO ECONOMIC CLASS SEEN IN OVER CROWDED LIVING PLACES FAMILY CLUSTERINGS 3 % OF UNTREATED INDIVIDUALS PROGRESS TO HAVE RHEUMATIC FEVER RHEUMATOGENIC STRAINS-5,6,18 ISOLATED STRAINS-GR A BETA HAEMOLITIC STRAINS

PATHOGENESIS DIRECT INFECTION OF GROUP A STREPTOCOCCUS TOXIC EFFECTS OF STREPTOCOCCAL PRODUCTS ON HEART TISSUES ABNORMAL /DYSFUNCTIONAL IMMUNE RESPONSE

STREPTOLYSIN O ANTGEN ANTIGEN MIMICRY SIMILARITY B/W-GROUP SPECIFIC CARBOHYDRATE OF GR A STREPTOCOCCAL GLYCOPROTEIN OF HEART VALVES STREPTOCOCAL M PROTEIN SIMILAR TO SARCOLEMMAL OF MYOCARDIAL CELL

DIAGNOSIS –JONES CRITERIA 2 MAJOR OR 1 MAJOR AND 2 MINOR CRITERIA MAJOR CRITERIA CARDITIS MIGRATORY POLY ARTHRITIS SYDENHAMS CHOREA ERYTHEMA MARGINATA SUBCUTANEOUS NODULES

MINOR CRITERIA FEVER /ARTHRALGIA ELEVATED ACUTE PHAGE REACTANTS PROLONGED PR INTERVAL PLUS THROAT C/S –POSITIVE G R A BETA HEMOLYTIC STREPTOCOCCI INCREASED ASLO

CARDITIS PANCARDITIS –PERI/MYO/ENDO CARDITIS SINUS TACHY CARDIA MITRAL REGURGITATION S3 GALLOP PERICARDIAL RUB CARDIOMEGALY FIBROSIS –THICKENING AND ADHESIONS- VALVULAR HEART DISEASE

MIGRATORY POLY ARTHRITIS 75 % MAJOR JOINTS –ANKLE,WRIST,KNEE,ELBOW, SALICYLATES

SYDENHAMS CHOREA –ST VITUS DANCE SUBCUTANEOUS NODULES –EXTENSOR SURFACES ERYTHEMA MARGINATUM-EFFERVACENT MACULAR ERUPTIONS

DIGNOSIS ASLO ANTI DEOXY RIBOSE NUCLEASE B ANTI HYALURONIDASE

TREATMENT ANTI STREPYTOCOCCAL TREATMENT CLINICAL MANIFESTATION 10 DAYS –PENNICILLIN ORAL -500 BID ERYTHROMYSIN250-4 TIMES DAILY IM BENZATHINE PENNICILLIN G-1.2 M UNITS ONCE IN 3 WKS-10 YRS ESP IN RHD

ARTHRITIS SALICYLATES -2 G ESR –TO MONITOR ONCE IN 2 WKS CARDITIS –GLUCOCORTICOIDES – PREDNISOLONE 30MGS 4-6 WKS TILL ACUTE PHASE REACTANTS ARE RETURNED TO NORMAL