Rheumatic fever and Rheumatic heart disease (RHD) is inseparable from epidemiological points.
Rheumatic Heart Disease is not a communicable disease but is the result of past communicable disease (streptococcal pharyngitis).
Rheumatic fever often leads to Rheumatic Heart Disease.
The consequences of RHD Include:
- Continue damage to the heart
- Increasing disability
- Repeated hospitalized
- Premature death usually by the age of 35 years or even earlier.
AGENT FACTOR:
1) Agent: The onset of RF or RHD is usually preceded by a streptococcal sore throat. It is believed that not all streptococcal strain leads to RF but strain which has rheumatic potential leads to RHD or RF.
2) Carrier: Carrier of it are frequent, e.g convalescent, transcient and chronic Carrier.
Eradication is not even theoretical possible of RHD or RF.
HOST AND ENVIRONMENTAL FACTOR:
1) Age: RF is the disease of childhood and adolescence (5-15 years) but it also occurs in adults.
2) Sex: Both sexes equal effect.
3) Immunity: Immune response against streptococcal that results in an attack of RF.
4) Socioeconomic status: RF is most seen in the lower Socio-economical public.
5) school-age children have more risk of disease.
Clinical Features | Rheumatic Heart Disease symptoms:
a) Fever which may be accompanied by sweating.
b) Polyarthritis occurred in most cases.
Commonly in small joints and also pain and swelling seen.
c) Carditis occurs in 60-70% of cases. it starts early in the course of RHF.
d) Nodules: nodules below skin seen after 4weeks of the onset of RF.
e) Abnormal jerky purposeless movement of the arms, leg and body is seen.
f) various type of skin rashes appear.
Rheumatic Heart Disease Diagnosis:
Diagnosis of RHD and RF are done manifestation given below 👇
- Carditis
- Polyarthritis
- Chorea
- Erythema
- Subcutaneous Nodules
- Fever
- Laboratory (increased ESR)
- Electrocardiogram: prolonged P-R interval
- Elevation in antistreptolysin-O level.
- Positive throat culture
- Rapid antigen test
- Recent scarlet fever
Rheumatic Heart Disease Prevention | Rheumatic Heart Disease treatment:
A. Primary prevention
Primary prevention is to prevent the primary attack of RF by identifying all streptococcal infection patients and treat them with penicillin.
To prevent some RF cases, we have to identify sever thousands of case of streptococcal throat infection must be identified and treated.
A good approach for it is high-risk group should be identified and they should keep under surveillance for streptococcal pharyngitis.
If streptococci are present, the child should be put on penicillin after the throat culture result comes positive for the culture.
If throat culture facilities not available there should be a start of penicillin for streptococcal pharyngitis.
B. Secondary Prevention
It contains that identifying those who have had RF and giving them one intramuscular injection of benzathine benzylpenicillin at intervals of 3 weeks.
This should continue for at least 5 years or until the child reaches 18 years whichever is later.
More severe valvular disease or post Valve surgery cases need life long treatment.
C. Non-medical measures
Improve living conditions because it is more seen in the low socio-economical condition.
D. In the evaluation of the program, the prevalence of RHD in school children from the periodic survey of random sample is probably the best indicator.
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