Acute rheumatic fever
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This document discusses rheumatic fever and rheumatic heart disease. It notes that susceptibility to rheumatic fever is partly hereditary, with certain HLA alleles being associated with increased or decreased susceptibility. Initial damage is caused by streptococcal bacteria invading epithelial tissues, though not through molecular mimicry. Common symptoms include chorea, indolent carditis, and valvular damage, which is a hallmark of rheumatic heart disease. Prolonged PR interval and softening of the first heart sound may also be seen. While bed rest was once recommended, medications are now preferred to control symptoms, and antibiotics are given long-term to prevent recurrence.
Acute rheumatic fever
- 3. Unfortunately such a decline was not replicated in developing countries, where these diseases continue unabated.
- 7. Susceptibility to ARF is an inherited characteristic鐚 with 44% concordance in monozygotic twins compared to 12% in dizygotic twins, Heritability more recently estimated at 60%. HLA-DR7 and HLA-DR4鐚 appear to be associated with susceptibility鐚 other class II alleles have been associated with protection (HLA- DR5, HLA-DR6鐚 HLA-DR5 1, HLA-DR52 and HLA-DQ )
- 8. . Initial damage is due to streptococcal invasion of epithelial surfaces鐚 With binding of M protein to type IV collagen allowing it to become immunogenic鐚 BUT NOT THROUGH THE MECHANISM OF MOLECULAR MIMICRY.
- 11. Chorea and indolent Carditis鐚 which may follow prolonged latent periods lasting up to 6 months.
- 21. VALVULAR DAMAGE IS THE HALLMARK OF RHEUMATIC CARDITIS
- 22. CAREYCOOMB
- 26. Myocardial inflammation may affect electrical conduction pathways, leading to P-R interval prolongation (first-degree atrio ventricular block or rarely higher level block) and softening of the first heart sound.
- 27. PROLONG PR INTERVAL NORMAL SINUS RHYTHM FIRST DEGREE HEART BLOCK
- 45. Traditional recommendations for long-term bed rest, once the cornerstone of management鐚are no longer widely practiced. Medications to control the abnormal movements do not alter the duration or outcome of chorea. Milder cases can usually be managed by providing a calm environment. In patients with severe chorea鐚 carbamazepine or sod i um valproate is preferred to haloperidol.
- 48. Best antibiotic for secondary prophylaxis is benzathine penicillin G delivered every 4 weeks.