Rheumatic Fever Flashcards
Rheumatic fever is the leading cause of
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.
Why has it decrease so significantly in places like Denmark
Houses, lifestyle
Who gets Rheumatic fever
Kids, burden carried by PI and maori.
NZ deprivation score shows maori and PI at the bottom of the spectrum. What does this mean in terms of Rheumatic fever distributions
30% increase risk with a high dep score, explains the uneven distribution of maori and PI vs pakeha
Why should we treat Rheumatic fever?
its PREVENTABLE, at a HIGH RATE and INEQUITABLE
Complications of rheumatic heart disease and surgery
- congestive heart failure
- drug side effects: warfarin, hepanin
- Pneumonia
- Cardiac arrhythmias
- endocarditis
- strokes
- death
How do we diagnose Rheumatic fever.
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!
Common pathway to Rheumatic fever/heart disease
1) Strep. pharyngitis (sore throat)
2) Rheumatic fever
What do ALL patients require for at least 10 year
Benzathine penicillin.
Rheumatic fever is really a _________ to strep. pharyngtis
Autoimmune response
MAJOR DEALS of Jones Criteria
- Carditis (heart)
- Polyarthritis (joints)
- Chorea (brain)
MINOR DEALS of Jones Criteria
-elevated acute phase reactants
(nodule)
-Erythrocyte sedimentation rate
What (within Jones criteria) is essential to diagnose Rheumatic fever?
2 major signs OR 1 major + 2 minor
and
supporting evidence of the strep infection as a precursor (throat swab ~50% reliable)
Carditis usually affects
Mitral or aortic valve
Arthritis
Extreme pain:
- suppressed by aspirin/NSAIDs, can make it harder to diagnose
- use paracetamol until diagnosed
Chorea
Very subtle Abnormal movements: -Can't keep limbs still -writing deteriorated -usually bilateral
Hard to diagnose
Is rheumatic fever genetically derived
There is evidence, but it seems it can be overcome by environment
Treatment options if there is NO CURE
Penicillin: Prevention
Acute RF: use paracetamol when diagnosis uncertain
Consequences long-term to Rheumatic Fever
Heart failure, atrial fibrillation, surgery, strokes, pregnancy issue
Long term issues!!!
Risk Factors for Rheumatic Fever
Social: housing/crowing, education
Economic: poverty
Health: Access to healthcare
Ethnic: disparities = poverty
Gold standard to prevent rheumatic fever?
injection of benzathine penicillin every 28 days
Why do we want to prevent recurrence
risk of carditis increases very every recurrence
How long do you have to do prevention of rheumatic fever after 1st attack (do diminish carditis)
for 10 years, or until 21.
This has greatly reduced hospital admission
Why did RF go away in developed countries??
USA: clear public health message “sore throats matter”
improved socio-economic status
EUROPE, NZ, AUSSIE
Strep. Pharyngitis is the only trigger!
Penicillin prevents rheumatic fever by treating strep throats.
Most patients pre rheumatic fever had a sore throat
Low risk vs high risk
Avoid antibiotics in low risk.
Look clearly at high risk, treat until diagnoses, look at siblings
Best way to treat sore throat is GAS +?
10 days po penicillin BD (oral)
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!
School based RF prevention
Focused on increasing healthcare access!
-transport, prescription costs, mild short illness in a busy house
Mainly in North Island
60% cases in auckland, mainly in decile 1 schools. This is just an indicator of
- health care access
- house crowding
- health knowledge
Primary care- to treat
Manaz kids, sore throat GP clinics
Antibiotic stewardess
make sure to avoid AB overuse
Other options for the future?
early prevention: in schools
Vaccines: very complicated, too many emm types, not anywhere near ready
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?
