Rheumatic Fever

Rheumatic fever

Acute rheumatic fever (ARF), commonly known as rheumatic fever, is an inflammatory condition that can affect the brain, heart, joints, skin, and skin tissue. Usually, the illness appears two to four weeks following a throat infection. Fever, several aching joints, uncontrollable muscle movements, and erythema marginatum, a distinctive but uncommon no-itch rash, are among the signs and symptoms. In nearly half of cases, the heart is implicated. Rheumatic heart disease (RHD), often known as a single case of ARF, is a chronic condition that causes irreversible damage to the heart valves. Heart failure could arise from the damaged valves. A person with defective valves is also more likely to experience valve infection and atrial fibrillation.

When the bacterium Streptococcus pyogenic infects the throat, acute rheumatic fever may develop.

Pathophysiology

A Group The branching polymer cell wall of streptococcus pyrogens can occasionally include the highly antigenic M protein. The immune system's antibodies to the M protein may interact with cardiac myosin, heart muscle glycogen, and smooth muscle cells in the arteries, leading to the production of cytokines and tissue deterioration. However, perivascular connective tissue is the only cross reaction that has been demonstrated. Complement is directly attached, causing inflammation, and neutrophils and macrophages are drawn in by Fc receptors. Characteristic On light microscopy, Aschoff bodies made of inflated eosinophilic collagen encircled by lymphocytes and macrophages can be detected. Aschoff gigantic cells or Anitschkow cells could develop from the bigger macrophages. Given that T-helper cells and macrophages predominate in acute rheumatic valvular lesions, a cell-mediated immune response may also be present.

Causes

• Pyrogens of the streptococcus
• Culture of the throat Rheumatic fever in the past
  • Risk factor
    • Malnutrition

Sign and symptoms

• A sore throat with fever
• Carditis
• Arthritis
• Subcutaneous nodules
• Erythema
• Fever
• Arthralgia

Diagnosis

• Leukocytosis
• Elevated ESR
• C-reactive protein
• ECG

Management and treatment

• Bed rest
  • All patients should remain in bed during the acute stage of an attack. The length of time spent in bed should be extended until all signs and symptoms stop manifesting.
• Diet
  • The youngster should have a regular, light diet, but salt intake should be limited if congestive heart failure is diagnosed as the patient's condition.
• Medicine
  • The patient should continue taking penicillin after getting throat cultures. The initial dose should be 4 insufficiency units of procaine penicillin, deep IM twice a day for 10 days. After that, 1.2 mega units of preventive benzathine penicillin are administered every 21 days cycle. Digoxin if you have congestive heart failure and carditis.
• Suppressive therapy
  • As suppressive therapy, aspirin or steroids are administered. The therapy will last for 12 weeks.

Others

Total rest, both physically and mentally. In cases of chorea, suggest taking phenobarbitone 30 mg three times a day.

Nursing management

• Encourage adherence to medication schedules.
• Support you emotionally.
• Halt the spread of a disease.
• During the disease's acute stage, allow for rest.
• Sustaining a healthy diet for children.
• Parents and children should talk about the dosage and adverse effects of the medication.
• Limit strenuous exercise.
• If the child has chlorea, use side rails in the bed and tell the parent not to leave the child alone.
• Check the child's vital signs every four hours or as needed.
• If a child has cardiac issues or was receiving treatment with a diuretic, monitor input and output.
• Provide a space for indoor play.
• Make time for expressing feelings aloud.
• Penicillin and other alternative medications, such as erythromycin, should be used as key preventive measures in health education regarding illness prevention. Giving long-acting penicillin at intervals of three weeks up until the age of 18 will help with secondary prevention, as would maintaining frequent doctor checkups.