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Acute Rheumatic Fever Overview and Management

Acute rheumatic fever is a common issue in developing countries, primarily affecting children aged 5-15 years, and develops 2-4 weeks after group A streptococcal pharyngitis due to immune-mediated mechanisms. Diagnosis is based on the Jones criteria, requiring evidence of recent GAS infection, and treatment includes antibiotics, anti-inflammatory drugs, and counseling. Prevention strategies involve primary and secondary prophylaxis with specific durations based on the presence of carditis and valvular involvement.

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18 views11 pages

Acute Rheumatic Fever Overview and Management

Acute rheumatic fever is a common issue in developing countries, primarily affecting children aged 5-15 years, and develops 2-4 weeks after group A streptococcal pharyngitis due to immune-mediated mechanisms. Diagnosis is based on the Jones criteria, requiring evidence of recent GAS infection, and treatment includes antibiotics, anti-inflammatory drugs, and counseling. Prevention strategies involve primary and secondary prophylaxis with specific durations based on the presence of carditis and valvular involvement.

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© © All Rights Reserved
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ACUTE RHEUMATIC

FEVER
Dr. Amina Akter
Assistant Professor
Department of pediatrics, GSVMCH
 Common problem in developing countries.
 Common between 5-15 yrs of age.

 Aetio-pathogenesis:
• Develops 2-4 wks after GAS pharyngitis.
• It is immune mediated and due to immune cross
reactivity( M protein, cell wall, CHO etc.)
Pathogenesis
GAS pharyngitis

Sensitization of B lymphocytes and formation of ab

Abs cross react with tissue ag

Inflammation

Heart Joints CNS Skin


Jones criteria
Major criteria Minor criteria

1. Migratory polyarthritis 1. Clinical features


• Arthalgia
2. Pancarditis
• Fever( >38C)
3. Sydenham’s chorea
2. Lab features
4. Subcutaneous nodules • Elevated acute phase
5. Erythema marginatum reactants( ESR, CRP)
• Prolonged P-R interval

Plus evidence of antecedent group A streptococcal infection


Diagnosis
• Initial attack:
2 major or 1 major, 2 minor criteria plus evidence of recent GAS
infection.

• Recurrent attack:
2 major or 1 major and 2 minor or 3 minor plus evidence of
recent GAS infection.
Diagnosis
• Mainly clinical
• Investigations:
 CBC
 AFR
 CXR
 ECG
Treatment :
1. Counselling about disease and prophylaxis
2. Supportive
3. Antibiotics :
• Benzathine penicillin inj ( single dose)
• Phenoxymethyl penicillin( 10 days orally)
• Amoxicillin etc.

4. Anti-inflammatory drugs: aspirin, prednisolone


• Aspirin : polyarthritis, isolated carditis without cardiomegaly or CCF
• Prednisolone: carditis and cardiomegaly or CCF
Prevention :
1. Primary prevention( initial attack)
2. Secondary prevention( prevention of subsequent attack)

Drugs: benzathine penicillin ,penicillin v, erythromycin etc


Duration of prophylaxis:
Prevention :
Duration of prophylaxis:

Category Duration after last attack


1. RF without carditis 1. 5 yrs or until 21 yrs of age
whichever is longer

2. RF with carditis but no 2. 10 yrs or until 21 yrs of age


valvular involvement

3. RF with carditis and 3. 10 yrs or until 40 yra of age


persistent valvular disease
Complications:

• Rheumatic valvular disease


• Mitral valve: MS,MR
• Aortic valve: AS, AR
Thank you all

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