Acute Rheumatic fever:
►RHD is the most common cause of heart disease in children in developing countries
►ARF is mainly a disease of children aged 5–14 years. Initial episodes become less common in older adolescents and young adults and are rare in persons aged >30 years. By contrast, recurrent episodes of ARF remain relatively common in adolescents and young adults.
►The most common clinical presentation of ARF is polyarthritis and fever. Polyarthritis is present in 60–75% of cases and carditis in 50–60%.
►Heart Involvement:
Up to 60% of patients with ARF progress to RHD. The endocardium, pericardium, or myocardium may be affected. Valvular damage is the hallmark of rheumatic carditis.
MC in Acute cases: MR
MC in Chronic cases: MS
MC overall: MR
►ARF almost always affects the large joints—most commonly the knees, ankles, hips, and elbows—and is asymmetric.
►Sydenham's chorea commonly occurs in the absence of other manifestations, follows a prolonged latent period after group A streptococcal infection, and is found mainly in females.
Clinical triad of:
Chorea
Hypotonia/weakness
Emotional lability / OCD / ADHD
►Skin Manifestations: The classic rash of ARF is erythema marginatum, It occurs usually on the trunk, sometimes on the limbs, but almost never on the face.
►The most common serologic tests are the anti-streptolysin O (ASO) and anti-DNase B (ADB) titers.
►The mainstay of primary prevention for ARF remains primary prophylaxis (i.e., the timely and complete treatment of group A streptococcal sore throat with antibiotics). If commenced within 9 days of sore throat onset, a course of penicillin (as outlined above for treatment of ARF) will prevent almost all cases of ARF that would otherwise have developed.
►RHD is the most common cause of heart disease in children in developing countries
►ARF is mainly a disease of children aged 5–14 years. Initial episodes become less common in older adolescents and young adults and are rare in persons aged >30 years. By contrast, recurrent episodes of ARF remain relatively common in adolescents and young adults.
►The most common clinical presentation of ARF is polyarthritis and fever. Polyarthritis is present in 60–75% of cases and carditis in 50–60%.
►Heart Involvement:
Up to 60% of patients with ARF progress to RHD. The endocardium, pericardium, or myocardium may be affected. Valvular damage is the hallmark of rheumatic carditis.
MC in Acute cases: MR
MC in Chronic cases: MS
MC overall: MR
►ARF almost always affects the large joints—most commonly the knees, ankles, hips, and elbows—and is asymmetric.
►Sydenham's chorea commonly occurs in the absence of other manifestations, follows a prolonged latent period after group A streptococcal infection, and is found mainly in females.
Clinical triad of:
Chorea
Hypotonia/weakness
Emotional lability / OCD / ADHD
►Skin Manifestations: The classic rash of ARF is erythema marginatum, It occurs usually on the trunk, sometimes on the limbs, but almost never on the face.
►The most common serologic tests are the anti-streptolysin O (ASO) and anti-DNase B (ADB) titers.
►The mainstay of primary prevention for ARF remains primary prophylaxis (i.e., the timely and complete treatment of group A streptococcal sore throat with antibiotics). If commenced within 9 days of sore throat onset, a course of penicillin (as outlined above for treatment of ARF) will prevent almost all cases of ARF that would otherwise have developed.
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