RHEUMATIC FEVER

DEFINITION
• Is defined as a systemic immuno mediated
Inflammatory disease caused by group A beta
haemolytic streptococcal infection
 ETIOLOGY
• Group A beta haemolytic streptococcus
 PATHOLOGY
• Follows throat infection by group A beta
hemolytic streptococcal infection

• An antibody is produced against M protein of

streptococcus, which has antigen similar to
those in heart and other tissues

• Thus it cross reacts with heart and renal tissues

 CLINICAL FEATURES
• MAJOR CRITERIA:
-migrating polyarthritis
-pancarditis
-Erythema marginatum
-Subcutaneous nodules
-chorea(sydenham’s chorea)
• MINOR CRITERIA: fever, arthralgia, previous rheumatic
fever, acute phase reactants(raised ESR and CRP),
leucocytosis prolonged PR interval plus

• Supporting features: recent scarlet fever,positive throat

culture, raised antistreptolysin O.
 INVESTIGATIONS
• Leucocytosis
• Raised ESR
• Raised CRP
• Prolonged PR interval in ECG
• Throat swab culture: group A beta hemolytic
streptococci
• Antistreptolysin O antibodies raised
 TREATMENT
• For prophylaxis: penicillin benzathine G-1.2
million units IM every 21-28 days
• For treatment of acute episode-benzathine
penicillin G: depending upon age and weight
0.6-1.2 million units IM
• Aspirin
• Corticosteroids(prednisolone)
• Treatment of congestive heart failure
 COMPLICATIONS
• Congestive cardiac failure
• Arrhythmias
• Pericarditis
• Valvular disease
 DIFFERENTIAL DIAGNOSIS
• Rheumatoid arthritis
• Endocarditis
• osteomyelitis
 PREVENTION
-Upper respiratory tract infection should be
treated early