Rheumatic Fever Flashcards

1
Q

Rheumatic fever is the leading cause of

A

ACQUIRED heart disease in NZ
Rheumatic fever can develop after a ‘strep throat’ – a throat infection caused by a Group A Streptococcus (GAS) bacteria.

Most strep throats get better and don’t lead to rheumatic fever. However, in a small number of people an untreated strep throat leads to rheumatic fever one to five weeks after a sore throat. This can cause the heart, joints, brain and skin to become inflamed and swollen.

While the symptoms of rheumatic fever may disappear on their own, the inflammation can cause rheumatic heart disease, where there is scarring of the heart valves.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Why has it decrease so significantly in places like Denmark

A

Houses, lifestyle

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Who gets Rheumatic fever

A

Kids, burden carried by PI and maori.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

NZ deprivation score shows maori and PI at the bottom of the spectrum. What does this mean in terms of Rheumatic fever distributions

A

30% increase risk with a high dep score, explains the uneven distribution of maori and PI vs pakeha

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Why should we treat Rheumatic fever?

A

its PREVENTABLE, at a HIGH RATE and INEQUITABLE

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Complications of rheumatic heart disease and surgery

A
  • congestive heart failure
  • drug side effects: warfarin, hepanin
  • Pneumonia
  • Cardiac arrhythmias
  • endocarditis
  • strokes
  • death
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

How do we diagnose Rheumatic fever.

A

An assessment of probability.

Kid will come in
-sore, swollen, large joints

  • Restless in school; poor handwriting (chorea, DD behaviour)
  • Short of breath; severe carditis

think of their deprivation level!

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Common pathway to Rheumatic fever/heart disease

A

1) Strep. pharyngitis (sore throat)

2) Rheumatic fever

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What do ALL patients require for at least 10 year

A

Benzathine penicillin.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Rheumatic fever is really a _________ to strep. pharyngtis

A

Autoimmune response

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

MAJOR DEALS of Jones Criteria

A
  • Carditis (heart)
  • Polyarthritis (joints)
  • Chorea (brain)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

MINOR DEALS of Jones Criteria

A

-elevated acute phase reactants
(nodule)

-Erythrocyte sedimentation rate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What (within Jones criteria) is essential to diagnose Rheumatic fever?

A

2 major signs OR 1 major + 2 minor

and

supporting evidence of the strep infection as a precursor (throat swab ~50% reliable)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Carditis usually affects

A

Mitral or aortic valve

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Arthritis

A

Extreme pain:

  • suppressed by aspirin/NSAIDs, can make it harder to diagnose
  • use paracetamol until diagnosed
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Chorea

A
Very subtle
Abnormal movements:
-Can't keep limbs still
-writing deteriorated
-usually bilateral

Hard to diagnose

17
Q

Is rheumatic fever genetically derived

A

There is evidence, but it seems it can be overcome by environment

18
Q

Treatment options if there is NO CURE

A

Penicillin: Prevention

Acute RF: use paracetamol when diagnosis uncertain

19
Q

Consequences long-term to Rheumatic Fever

A

Heart failure, atrial fibrillation, surgery, strokes, pregnancy issue
Long term issues!!!

20
Q

Risk Factors for Rheumatic Fever

A

Social: housing/crowing, education

Economic: poverty

Health: Access to healthcare

Ethnic: disparities = poverty

21
Q

Gold standard to prevent rheumatic fever?

A

injection of benzathine penicillin every 28 days

22
Q

Why do we want to prevent recurrence

A

risk of carditis increases very every recurrence

23
Q

How long do you have to do prevention of rheumatic fever after 1st attack (do diminish carditis)

A

for 10 years, or until 21.

This has greatly reduced hospital admission

24
Q

Why did RF go away in developed countries??

A

USA: clear public health message “sore throats matter”
improved socio-economic status

EUROPE, NZ, AUSSIE

25
Strep. Pharyngitis is the only trigger!
Penicillin prevents rheumatic fever by treating strep throats. Most patients pre rheumatic fever had a sore throat
26
Low risk vs high risk
Avoid antibiotics in low risk. Look clearly at high risk, treat until diagnoses, look at siblings
27
Best way to treat sore throat is GAS +?
10 days po penicillin BD (oral)
28
access to healthcare is an issue in NZ. Acute RF is known to be reduced by good healthcare
clinical schools (27) vs control school (27) ~12,000 kids each group Clinical schools: trained lay workers (classroom visits), throats swabbed, . Underpowered so study couldn't be finished!
29
School based RF prevention
Focused on increasing healthcare access! -transport, prescription costs, mild short illness in a busy house Mainly in North Island
30
60% cases in auckland, mainly in decile 1 schools. This is just an indicator of
- health care access - house crowding - health knowledge
31
Primary care- to treat
Manaz kids, sore throat GP clinics
32
Antibiotic stewardess
make sure to avoid AB overuse
33
Other options for the future?
early prevention: in schools Vaccines: very complicated, too many emm types, not anywhere near ready
34
More CHALLENGES
RHD in young adults undetected RHD in pregnancy Science questions (auto-immune, vaccines etc, but a lack of interest) Burden of disease in the developing world, so how will fund?