Rheumatic fever

Acute or subacute arthritis of rheumatic fever

Acute rheumatic valvulitis

Acute rheumatic carditis

Rheumatic fever, also called " Streptokokkenrheumatismus " is a today in industrialized countries rarely diagnosed rheumatic inflammatory systemic disease of skin, heart, joint and brain.

It occurs as a result of disease after infection with β -hemolytic group A streptococci. Often these infections of the upper airways run with only mild symptoms. It mainly ill children and adolescents after a tonsillitis or pharyngitis streptococcal.

In older adults, the disease is often due to atypical patterns is difficult to diagnose. The number of heart valve disease in adults in Europe is however still at 3-4 %. The majority of these valve disease is a bacterial nature or arteriosclerotic related. A rheumatic reaction is difficult to rule out.

Symptoms

One to three weeks occurred after the preceding streptococcal infection on characteristic symptoms, which ( according to T. Duckett Jones and Edward Franklin Bland ) and in " minor symptoms " are classified as Jones standard " major criteria ".

  • Major criteria: Carditis (heart inflammation), v. a subacute endocarditis
  • Pericarditis ( pericarditis )
  • Myocarditis (heart muscle inflammation)
  • Minor symptoms: fever
  • Joint pain ( arthralgia)
  • Increased non-specific inflammatory markers in the blood: erythrocyte sedimentation rate (ESR) ↑, ↑ CRP,
  • Already made ​​by rheumatic fever or rheumatic valvular
  • Prolonged PR interval or PR time in the ECG

Assessment of the Jones criteria

The diagnosis is well established with proof of previous streptococcal infection ( throat swab / elevated or rising antistreptolysin ) and when two major criteria or one major criterion plus two minor symptoms are present.

Therapy

The treatment of streptococcal type infection occurs with penicillin, penicillin allergy with a macrolide antibiotic. Case of proven rheumatic fever with heart involvement an anti-inflammatory treatment with aspirin is indicated. If this is not sufficiently effective, it must be done with cortisone. If you suspect a scattering stove, an operational renovation done this focus ( eg, tonsillectomy ). The prevention of relapse after annealing the streptococcal infection occurs with penicillin, penicillin allergy is treated here with a macrolide antibiotic. After a carditis with lasting valvular heart disease prophylaxis is carried out for at least ten years, at least until they reach the age of 40, after a carditis without valvular it is to reach adulthood and at least ten years necessary without previous carditis they want to reach of 21 years and be carried out at least five years.

Forecast

The prognosis is determined primarily by the disease of the heart ( carditis ) and their consequences ( recurrences and rheumatic valvular heart disease ). The mortality is expressed with 2 to 5%. All other symptoms heal without consequence.

Approximately 50% of patients with acute rheumatic fever develop chronic rheumatic heart disease.

Group A streptococcal infection Sydenham's chorea PANDAS Rheumatoid nodule C-reactive protein Electrocardiography Medical guideline
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