Today is our topic of discussion Rheumatic Fever and Rheumatic Heart Disease
Rheumatic Fever and Rheumatic Heart Disease
RF and RHD is the commonest heart ailment among the pediatric age-group and young adults. Poverty, overcrowding, lack of nutrition and health education concentrates the problem more.
Pathology:
RHD results from repeated attacks of RF that produce rigidity and deformity of valve cusps. fusion of the commissures, or shortening of the chordae tendine. Mitral and/ aortic valvular stenosis or regurgitation results.
Diagnosis of RF:
Based on Jones criteria; presence of two major or one major and two minor criteria with evidence of streptococcal sore throat, establishes the diagnosis –
Major criteria:
Carditis –
Mostly present in children and adolescents. Features of carditis: (1) pericarditis; (2) cardiomegaly, detected by physical signs, radiography, or echocardiography: (3) CHF, with painful liver enlargement (4) mitral or aortic valve murmurs.
Erythema marginatum
Subcutaneous nodules –
Small (<2 cm in diameter), firm, and non-tender and are attached to fascia or tendon sheaths.
Sydenham chorea –
involuntary movements primarily of the face, tongue, and upper extremities.
Polyarthritis –
Migratory polyarthritis involving large joints. The arthritis lasts 1-5 weeks and subsides without residual deformity. Prompt response of arthritis to therapeutic doses of Aspirin or non-steroidal agents is characteristic.
Minor criteria:
Fever, arthralgia, previous RF and elevated ESR or CRP. Supporting evidence includes positive throat culture or raised ASO titer and leukocytosis.
Epidemiological factors:
Agent factors:
Agent:
Few strains of group A streptococcus bacteria causes sore throat or pharyngitis.
Carriers:
Carriers of group A streptococcus are frequent.
Host and environmental factors :
Age:
Typically it is a disease of young (5 to 15 years).
Sex:
Females more commonly affected than male.
Immunity:
A toxin (called streptolysin-O) is liberated by group A streptococcus bacteria. The corresponding antibody of the toxin cross-reacts with cardiac valve tissue, causing damage.
Socio-economic status:
The disease is linked to poor housing, over-crowding, poverty, inadequate health care service and low level of awareness about the disease and its consequence.
High risk groups:
School-age children 5-15 years old, slum dwellers and living in a closed community. [For management of rheumatic fever students are referred to see any standard medicine text book]
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