Rheumatic Fever Flashcards Preview

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Flashcards in Rheumatic Fever Deck (34):
1

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.

2

Why has it decrease so significantly in places like Denmark

Houses, lifestyle

3

Who gets Rheumatic fever

Kids, burden carried by PI and maori.

4

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

5

Why should we treat Rheumatic fever?

its PREVENTABLE, at a HIGH RATE and INEQUITABLE

6

Complications of rheumatic heart disease and surgery

-congestive heart failure
-drug side effects: warfarin, hepanin
-Pneumonia
-Cardiac arrhythmias
-endocarditis
-strokes
-death

7

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!

8

Common pathway to Rheumatic fever/heart disease

1) Strep. pharyngitis (sore throat)

2) Rheumatic fever

9

What do ALL patients require for at least 10 year

Benzathine penicillin.

10

Rheumatic fever is really a _________ to strep. pharyngtis

Autoimmune response

11

MAJOR DEALS of Jones Criteria

-Carditis (heart)
-Polyarthritis (joints)
-Chorea (brain)

12

MINOR DEALS of Jones Criteria

-elevated acute phase reactants
(nodule)

-Erythrocyte sedimentation rate

13

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)

14

Carditis usually affects

Mitral or aortic valve

15

Arthritis

Extreme pain:
-suppressed by aspirin/NSAIDs, can make it harder to diagnose
-use paracetamol until diagnosed

16

Chorea

Very subtle
Abnormal movements:
-Can't keep limbs still
-writing deteriorated
-usually bilateral

Hard to diagnose

17

Is rheumatic fever genetically derived

There is evidence, but it seems it can be overcome by environment

18

Treatment options if there is NO CURE

Penicillin: Prevention

Acute RF: use paracetamol when diagnosis uncertain

19

Consequences long-term to Rheumatic Fever

Heart failure, atrial fibrillation, surgery, strokes, pregnancy issue
Long term issues!!!

20

Risk Factors for Rheumatic Fever

Social: housing/crowing, education

Economic: poverty

Health: Access to healthcare

Ethnic: disparities = poverty

21

Gold standard to prevent rheumatic fever?

injection of benzathine penicillin every 28 days

22

Why do we want to prevent recurrence

risk of carditis increases very every recurrence

23

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

24

Why did RF go away in developed countries??

USA: clear public health message "sore throats matter"
improved socio-economic status

EUROPE, NZ, AUSSIE

25

Strep. Pharyngitis is the only trigger!

Penicillin prevents rheumatic fever by treating strep throats.

Most patients pre rheumatic fever had a sore throat

26

Low risk vs high risk

Avoid antibiotics in low risk.

Look clearly at high risk, treat until diagnoses, look at siblings

27

Best way to treat sore throat is GAS +?

10 days po penicillin BD (oral)

28

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!

29

School based RF prevention

Focused on increasing healthcare access!
-transport, prescription costs, mild short illness in a busy house

Mainly in North Island

30

60% cases in auckland, mainly in decile 1 schools. This is just an indicator of

-health care access
-house crowding
-health knowledge

31

Primary care- to treat

Manaz kids, sore throat GP clinics

32

Antibiotic stewardess

make sure to avoid AB overuse

33

Other options for the future?

early prevention: in schools

Vaccines: very complicated, too many emm types, not anywhere near ready

34

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?