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Disease RHEUMATIC FEVER
   
Quotation “The flexible stethoscope is a very handy instrument to relieve us from fatiguing and not very delicate posture”
   
Definition A multi-system inflammatory disease concurring in a genetically susceptible host after upper respiratory tract infection with group A streptococcus (GAS)
   
Prognosis Only 3% of classic sore throat with fever, exhudate, and anti-strptolysin titre are followed by rheumatic fever, and less than 0.3% of severe pharyngitis do so. Immediate mortality of acute Rheumatic fevr is 1-2%. Persistent carditis for weeks implies a poor prognosis, and 30% of these die within 10 years. Within 10 yearss, two-thirds of patients will have a detectable valve lesion. Children and those who have carditis during their illness are more likely to have recurrences of rheumatic fever.  Both initial attacks and recurrences can be completely prevented by treatment of streptococcal infection with penicillin. 
   
Treatment

Suspect when a child with fever has joint pain, joint swelling, or has tachycardia, chest pain or murmur.

 

Complete bed rest x 2 weeks.

Inj. Procain pencilin 4-8 lac units x IM x ATD x OD x 10 days.

 

If pencilin sensitive,

 

Tab. Erythromycin 125-250mg Qid x 10 days.

Tab. Disprin x ½ -1tds x till there is symptomatic relief.

Tab. Wysolene 5mg ½ - 1 tds x 6 weeks. If carditis or if aspirin does nit give full relief.

 

Follow up with prophylactic treatment.

Inj. Penidure 12 lacs IM x ATD x every month till the age of 25 years.

 

If pencilin sensitive

 

Tab. Erythromycin 250mg OD.

 

Whenevery any surgery or tooth extraction is done. Inj. Pencilin 10lacs IM x ATD x OD x 3 days.

 

Prompt treatment of throat infections ( and of rheumatic fever) in child hood will prevent many heart lesions.

 

Inj. Procain pencilin

Tab. Disprin

Inj. Penidure


 

 

WYSOLONE ERYCIN 
   
General Measures Bed rest as detailed above.  Advance activity very cautiously in those with evidence of carditis.
   
Advice to Patient Need for proper therapy of streptococcal sore-throat. Importance of prophylaxis to be understood.
   
Follow Up Each week initially and then every 6 months, detect cardiac lesion if any.
   
Inadequate Response Full doses of aspirin, and use of steroids if necessary.
   
Prevention Adequate treatment of Streptococcal throat infections – With Penicillin or Erythromycin as suggested above. Oral Penicillin V Potassium (500mgs 4 times a day) for 10 days.  Prevention of recurrences Benzathine Penicillin 1.2 million units IM every 4 weeks or Oral Penicillin G (400,000 units bid), or Erythromycin 250mgs bid, or Sulfadiazine 1.0 Gm daily  For those with No evidence of carditis at the initial attack, propylaxis is recommended for a minimum period of 5 years, after the first attack, and until the age of 20, whichever is longer. For patients with rheumatic heart disease, prophylaxis should be continued until the age of 30.
   
Reference From Website: www.emedicine.com/emer/topic509.html
   

 
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