Rheumatic Fever Causes, Symptoms, And Treatment

Rheumatic Fever Causes, Symptoms, And Treatment

Question. Describe the definition, etiology, clinical features, diagnostic criteria, and management of acute rheumatic fever.
Or
Discuss etiology, clinical features, diagnostic criteria, and management of acute rheumatic fever.

Answer.

Symptoms of Rheumatic Fever

1. Pyrexia of unknown origin.
2. Arthralgia, i.e. pain in joints. Pain in joints is fleting and migratory.

Signs Rheumatic Fever

Carditis Rheumatic Fever

1. It is pancarditis involving endocardium, myocardium and pericardium.
2. It manifests as breathlessness, palpitation and chest pain.
   tachycardia, cardiomegaly and new or change murmurs.
3. Aortic regurgitation in 50% cases.
4. Pericarditis produces frictional rub and pericardial tenderness.
5. Cardiac failure due to myocardial infarction.

Sydenham’s chorea rheumatic fever

1. Late neurological manifestations that occurs at least three months after the episode of acute rheumatic fever when all signs disappear.
2. More common in female.
3. It is characterized by involuntary dancing movements of hands, feet or face.

Arthritis rheumatic fever

1. Early feature of illness and is non-specifi.
2. It is characterized by acute painful symmetric and migratory inflmmation of large joints.

Erythema Marginatum rheumatic fever
Red macules which fade in center but remain red at the edges and occur mainly on trunk and proximal extremities on face.

Subcutaneous nodules

1. They are small, dense and fim and painless and are best felt over tendons and bones.
2. Nodules appear more than 3 weeks after onset of other manifestations.

Respiratory rheumatic fever
Epistaxis is an atypical manifestation.

Gastrointestinal rheumatic fever

Mild gastroenteritis is present. Repeated vomiting spells are present.

Clinical Manifestations Acute Rheumatic Fever.

1. Prodromal phase: Tonsillitis or sore throat 1 to 4 weeks prior to onset of acute rheumatic fever. Besides this anorexia, pallor, fatigability and nervous irritability is present.
2. Latent phase: When antibodies to preceding streptococcal infection are produced.
3. Phase of onset of rheumatic fever/mode of onset.
   Arthritis and fever 2–3 weeks after infection.
4. Cardiac symptoms 3–6 weeks after infection is fist to draw attntion.
5. Abdominal symptoms: Abdominal pain and tenderness, nausea, vomiting, fever and leukocytosis.
6. Pyrexia of unknown origin
7. Typhoid or inflenzal mode of onset with fever
8. Nodules of skin lesion.

Treatment Of Acute Rheumatic Fever

1. Bed rest is important to reduce joint pain and cardiac workload.
   Duration of bed rest is guided by markers of inflmmation like temperature, WBC count and ESR.
2. Benzathine penicillin 1.2 mu IM 4 hourly.
   If patient is allergic to penicillin, erythromycin 40–50 mg / kg for ten days is given.
3. Aspirin usually relieves symptom of arthritis rapidly.
   A starting dose of 60 mg / kg body weight per day is given divided into 6 doses.
   The dose may be increased to 120 mg / kg body weight.
   This dose may produce severe symptoms like vomiting, tachypnea and acidosis is given till ESR comes to normal.
4. Corticosteroids like prednisolone produces rapid symptomatic relief than aspirin and is indicated in cases with severe arthritis or carditis.
   Prednisolone is given in doses of 1.2 mg / kg body weight till ESR comes to normal.