Year , Volume 13 , Issue 1, Pages 31 - 39 Zotero Mendeley EndNote. Abstract en tr Acute rheumatic fever ARF is more common in developing countries. Rheumatic valvular disease is caused by autoimmune responses. A single intramuscular IM injection of benzathine penicillin or oral penicillin V phenoxymethylpenicillin is administered as primary prophylaxis for 10 days.
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Acute rheumatic fever is a delayed sequela of pharyngitis due to Streptococcus pyogenes , which are also called group A Streptococcus or group A strep. The etiology, clinical features, diagnosis and treatment options, prognosis and complications, and prevention are described below.
Acute rheumatic fever is a nonsuppurative, delayed sequela of pharyngitis due to S. The exact disease process is not fully known. However, the disease is in part due to an autoimmune response to S. Organ systems involved typically include the heart, joints, and central nervous system. Streptococcal pharyngitis typically precedes the onset of acute rheumatic fever by 1 to 5 weeks. Figure 1. Streptococcus pyogenes group A Streptococcus on Gram stain.
Clinical signs of carditis include cardiomegaly, new onset heart murmur usually with mitral or aortic valvular disease , pericardial friction rub, pericardial effusion, and congestive heart failure.
Additionally, a prolonged PR interval can be seen on electrocardiography. Subclinical carditis may also be present. Polyarthritis is the major musculoskeletal manifestation.
The arthritis is typically migratory and involves the following large joints: elbows, wrists, knees, and ankles. Joint involvement may range from general arthralgia to a painful, inflammatory arthritis. Subcutaneous nodules and erythema marginatum are the two major skin manifestations. Subcutaneous nodules are firm, painless, variable in size typically between a few millimeters and 2 centimeters in diameter , and usually found over joint extensor surfaces.
Nodules are most commonly present in patients with carditis. Erythema marginatum is an erythematous, non-pruritic, non-painful macular lesion on the trunk or proximal extremities. Lesions are transient and tend to extend outward with central clearing and are often described as serpiginous. Vitus dance, is the major central nervous system manifestation. Chorea is a neurological disorder characterized by abrupt, purposeless, non-rhythmic, involuntary movements that is often associated with muscle weakness and emotional lability.
Chorea often appears after the other manifestations of acute rheumatic fever. It also can appear as the only manifestation of acute rheumatic fever. In approximately one-third of patients, acute rheumatic fever follows subclinical streptococcal infections or infections for which medical attention was not sought.
Individuals with a history of acute rheumatic fever have an increased risk of recurrence with subsequent streptococcal pharyngeal infections. The incidence of acute rheumatic fever is highest in children between the ages of 5 and 15 years. Acute rheumatic fever is very rare in children 3 years of age and younger in the United States. First-onset acute rheumatic fever is rare in adults, although recurrence may occur through adulthood.
Crowding, such as found in schools, military barracks, and daycare centers, increases the risk of spreading group A strep and thus increases the risk of developing acute rheumatic fever. The differential diagnosis of acute rheumatic fever is broad due to the various symptoms of the disease. There is no definitive diagnostic test for acute rheumatic fever. A clinical diagnosis of acute rheumatic fever should be made using the Jones Criteria.
A revised version of the Jones Criteria endorsed by the American Heart Association now includes the addition of subclinical carditis as a major criteria and stratification of the major and minor criteria based upon epidemiologic risk e. The presence of 2 major manifestations or 1 major and 2 minor manifestations see below indicates a high probability of an initial acute rheumatic fever illness in any risk population.
More than one joint and more than one cardiac manifestation can only be classified as either one major or one minor criteria, not both. For example, if there is evidence of carditis a major criteria , a prolonged PR interval should not also be counted as a minor criteria. Similarly, if there is evidence of arthritis a major criteria , then arthralgia should not also be counted as a minor criteria. In most cases, there should also be evidence of preceding group A streptococcal infection.
Prolonged PR interval on electrocardiography, after accounting for age variability unless carditis is a major criterion.
Those not included in the low-risk population are defined as moderate or high risk depending upon their reference population. In some instances, a presumptive diagnosis of acute rheumatic fever can be made without fulfilling the Jones Criteria. For example, when clinical evidence is lacking in areas of high acute rheumatic fever incidence, clinical judgment must be used regarding the appropriate diagnosis and use of antibiotic prophylaxis.
Individuals with a history of rheumatic heart disease or prior episode of acute rheumatic fever are at increased risk for recurrences of acute rheumatic fever. If relying on the presence of 3 minor manifestations, the diagnosis of recurrent acute rheumatic fever should only be made if other more likely causes have been excluded.
Patients with acute rheumatic fever should start on therapy for the symptomatic management of acute rheumatic fever, including salicylates and anti-inflammatory medicines to relieve inflammation and decrease fever, as well as management of cardiac failure. These patients should also be started on antibiotics for treatment of group A strep pharyngitis, regardless of the presence or absence of pharyngitis at the time of diagnosis, in order to eradicate any residual group A strep carriage.
Rheumatic heart disease is the most important long-term sequela of acute rheumatic fever due to its ability to cause disability or death. Prognosis is related to the prevention of recurrent attacks, degree of cardiac valvular damage, and degree of overall cardiac involvement.
Cardiac complications may vary in severity and include, but are not limited to, pericarditis, endocarditis, arrhythmias, valvular damage, and congestive heart failure. However, in about one-third of patients, acute rheumatic fever follows subclinical streptococcal infections or infections for which medical attention was not sought.
Secondary prevention of rheumatic fever requires antibiotic prophylaxis to reduce the likelihood of recurrent attacks in persons with a history of acute rheumatic fever. Because acute rheumatic fever frequently recurs with subsequent group A strep pharyngitis infections, long-term prophylaxis duration should be individually tailored but is usually indicated at least until age Prophylaxis typically involves an intramuscular injection of benzathine penicillin every 4 weeks or oral penicillin V twice daily.
Sulfadiazine or oral macrolides can be taken daily by individuals who are allergic to penicillin. The spread of group A strep infection can be reduced by good hand hygiene, especially after coughing and sneezing and before preparing foods or eating, and respiratory etiquette e. Treating an infected person with an antibiotic for 24 hours or longer generally eliminates their ability to transmit the bacteria. Thus, people with group A strep pharyngitis should stay home from work, school, or daycare until afebrile and until at least 24 hours after starting appropriate antibiotic therapy.
The incidence of acute rheumatic fever has declined significantly in the developed world over the last century and now is significantly less common in the United States compared to less developed countries. The annual national incidence of acute rheumatic fever in the United States is largely unknown as it is no longer a nationally notifiable disease; however, there is likely significant regional variation.
For instance, Hawaii and American Samoa have higher annual incidence rates than the continental United States, and may be as high as 1. Top of Page. Section Navigation. On This Page. Related Links. Links with this icon indicate that you are leaving the CDC website. Linking to a non-federal website does not constitute an endorsement by CDC or any of its employees of the sponsors or the information and products presented on the website.
Akut Romatizmal Ateş Tanısı Anti-Streptolizin O ile Konulabilir Mi?
Background: The aim of this study was to determine the incidence of acute rheumatic fever ARF in Turkish children. Material and Methods: Our data was collected from the population and hospital based studies in Turkey between and We examined 12 studies reported from Turkey between these dates. Results: Between , , ; , , patients had been followed up, respectively.
Akut romatizmal ateş tanısında güncelleme: 2015 Jones ölçütleri.
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Acute Rheumatic Fever
It poses serious economic problem at individual, communal and national levels through direct and indirect health care costs. The objective of this article is to review acute rheumatic fever in the global context with some emphasis on the continuing burden of this disease in the developing settings. The review shows that acute rheumatic fever still occurs under conditions of impoverished overcrowding and poor sanitation and where access to healthcare services is limited. Since acute rheumatic fever is a preventable disease, improved housing and sanitation, access to effective healthcare services, early diagnosis, registration of cases and follow up remain the bedrock of the control of this disease. Anahtar Kelime: Acute rheumatic fever, rheumatic heart disease, developing countries. Benzer Makaleler. Dergi Bilgileri.
Aim: To evaluate the clinical features of children diagnosed as having acute rheumatic fever between June and November , and the changes observed in patient groups in comparison with data obtained in previous years. The diagnosis of acute rheumatic fever was made using the updated Jones criteria. Material and methods: The medical records of pediatric patients who were diagnosed as having acute rheumatic fever between June and November using the updated criteria, were examined retrospectively. The data of a previous study that used the old criteria were reorganized and the two groups were compared. Manifest carditis was found in 24 patients and silent carditis was found in 18 patients. Erythema marginatum and subcutaneous nodules were not found in our patients. When compared with the previous study, an increase in the rate of silent carditis from