L.33 Rheumatic fever

Question 1

What is the Pathogenesis of RHD

Answer 1

Strep. pyogenes (A) infection (sore throat, skin sores.

-Immune dysregulation that leads to acute rheumatic fever

Question 2

What are the Clinical manifestations of RHD

Answer 2

Sore swollen joints, Fever,
skin rashes,
Long term: heart valve scarring, acute carditis (acute rheumatic fever) goes to chronic rheumatic heart disease- adults
Then later it goes on to heart failure, heart valve infections, arrhythmia.

Question 3

What is the Treatment for RHD

Answer 3

Rheumatic fever prevention: continuous antibiotic prophylaxis through intramuscular benzathine penicillin, injection every 28 days. - until 21 yo unless severe 30+ yo

Use nsaid for arthritis
Ace inhibitors, diurectic for cardiac reaction
Bed rest

Question 4

What is the Impact on families for RHD

Answer 4

Racism, heavy treatment.

Question 5

How can you diagnose

Answer 5

Diagnos

Question 6

How can you diagnose

Answer 6

Major
Sore swollen large joint. (mono/polyarthritis)- suppressed by aspirin/NSAID- use paracetamol

Restless in school/ can’t write: rheumatic chorea- immune dysregulation affects basal ganglia to cause involuntary movements

-Short of breath: health valve damage (carditis) from echocardiagram

Minor
-Elevated acute phase reactants
-Erythrocyte sedimentation rate 
-Supporting evidence of strep A infection- antibody
So need 2 maj, 1 maj + 2 minor.

Question 7

What is carditis

Answer 7

The left sided heart valves, mostly the mitral> aortic. Causes regurgitation. There is a some scarring, damage of heart valves

Question 8

What is the differential diagnosis for migratory

Answer 8

Autoimmune reaction
Acute infection septic arthritis.
Leukemia

Question 9

What are some public health interventions for RHD

Answer 9

• Sore throat clinic in schools

- Free antibiotic prophylaxis