DOCSLIB.ORG

The Differential Diagnosis of Rheumatic Fever

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
The Differential Diagnosis of Rheumatic Fever Arch Dis Child: first published as 10.1136/adc.33.170.350 on 1 August 1958. Downloaded from THE DIFFERENTIAL DIAGNOSIS OF RHEUMATIC FEVER BY K. A. HALLIDIE-SMITH and E. G. L. BYWATERS From the Rheumatism Research Unit (Medical Research Council), Canadian Red Cross Memorial Hospital, Taplow (RECEIVED FOR PUBLICATION JANUARY 29, 1958) Since the efficacy of continuous daily sulphona- Jones, save that chorea was excluded as a major mide or penicillin administration in the prevention criterion and past rheumatic fever as a minor of attacks of rheumatic fever has now been estab- criterion. In addition, 42 cases were discharged with lished, and the measure recommended not only a diagnosis of 'possible rheumatic fever' and 202 with nationally but by international committees (World a diagnosis of Still's disease, the remaining 1,011 Health Organization, 1957), it has become increas- cases being various other miscellaneous disorders. ingly important to recognize even mild cases of rheumatic fever. At the same time it is equally Group A. Erroneous Initial Diagnoses in Rheumatic essential to avoid diagnosing this erroneously, since Fever Cases the resulting continuous daily prophylaxis is A one-in-six sample of these patients ultimately undesirable from the point of view both of the diagnosed as rheumatic fever was taken, consisting patient and of the tax-payer. We thought therefore of those with surnames beginning with the initials that an account of our observations at this National A, B and C admitted between July, 1947, and June, copyright. Centre for Juvenile Rheumatism over the last nine 1956. In this group of 160 rheumatic fever patients, years would be useful, since over this period there 12 were found definitely to have been initially other- has accumulated considerable experience not only wise diagnosed, though subsequently all satisfied of rheumatic fever, but also of many conditions Duckett Jones' criteria for the diagnosis of rheumatic which masquerade as such. fever. All were children between the ages of 6 and Out of such prolonged experience at the House of 12 years, apart from the patient initially thought to the Good Samaritan in Boston, Duckett Jones (1944) have sub-acute bacterial endocarditis, and only in was able to formulate a set of diagnostic criteria that patient and the child thought to be a case of which have proved extremely useful in a modified Still's disease was the ultimate diagnosis not made http://adc.bmj.com/ form (Rheumatic Fever Committee Joint Report, before transfer here. All patients have been regularly 1955) for ensuring in a large therapeutic trial that followed up since discharge, for periods between cases from many different centres were of the same 18 months and seven years. general type. He realized that cases of other diseases were as far as possible to be ruled out. It was realized Poliomyelitis. These two children complained of fever and limb pains and one had neck stiffness. Normal further that many cases of genuine rheumatic fever, cerebrospinal fluid was found and in both significant if first observed late in the course of the disease, or heart murmurs became audible subsequently. if mild, could not be fitted in and would have to be on October 1, 2021 by guest. Protected called 'probable rheumatic fever'. Furthermore, Pneumonia. This 9-year-old girl gave a history of some general malaise and limb pains. On admission to the of the criteria depend upon continuous clinical referring hospital, she was febrile and was found to have observation or laboratory tests usually possible in impaired percussion note and crepitations in the right hospital, but only comparatively rarely made in this mid-zone. Following subsidence of the chest signs she country in the average general practice. In this centre developed significant heart murmurs, and later rheumatic then, a discharge diagnosis of rheumatic fever has nodules. been made on unformulated but rather wider grounds Meningitis. This child had a sore throat followed by than those of the Duckett Jones criteria, so that of limb pain and headache. Normal cerebrospinal fluid was 2,214 patients admitted to the unit over the nine-year obtained and she subsequently developed polyarthritis period, 959 were discharged with the diagnosis of and heart block. rheumatic fever. Nearly two thirds of these satisfied Rubella. This 7-year-old girl had a sudden onset of diagnostic criteria comparable to those of Duckett abdominal pain and a rubella-like rash. There was, how- 350 Arch Dis Child: first published as 10.1136/adc.33.170.350 on 1 August 1958. Downloaded from DIFFERENTIAL DIAGNOSIS OF RHEUMATIC FEVER 351 ever, a normal white count and no accompanying TABLE 1 lymphadenopathy; she subsequently developed peri- FINAL DIAGNOSIS OF 196 CASES REFERRED AS RHEU- and endocarditis. MATIC FEVER IN WHOM THIS DIAGNOSIS WAS NOT carditis CONFIRMED Functional (8): Dysentery. This girl complained of abdominal pain, Physiological tachycardia 3 diarrhoea and limb pains. Stool culture was negative. Hysteria. 3 Neurosis and depression 2 She complained of limb pains after the diarrhoea settled Traumatic and Postural (11): and an organic mitral pansystolic murmur developed. Sprains 5 Slipped femoral epiphysis 2 Torn cartilage, osteochondritis dissecans, chest deformity and Subacute Bacterial Endocarditis. This young adult back ache-1 each 4 female with known rheumatic heart disease gave a five-day Infections (91): Upper respiratory tract 45 history of general malaise, generalized aches and pains Lower respiratory tract 10 and fever. She subsequently developed polyarthritis and Bone andl joint 10 Blood strlamr 4 a raised antistreptolysin-0 titre; repeated blood cultures Usinary -act 4 were negative and there were no embolic manifestations. Pericarditis 2 Specific fevers 16 She responded to bed rest and salicylates. Connective rissue Disorders (42): Still's and rheumatoid arthritis 24 Appendicitis. These two children both complained of Schonlein-Henoch purpura 8 Erythema nodosum 5 abdominal pain. Normal appendices were removed, but Visceral Itipus erythematosus 2 they both subsequently developed polyarthritis and Periarteritis nodosum. Penicillin sensitivity organic heart murmurs. Granuloma annulare Rheumatic and Congenital Heart Disease (9): Suppurative Arthritis of Hip. This 9-year-old boy had Congenital Rheumatic a four weeks' history of pain in one hip with inguinal Blood Dyscrasias (2): adenitis and fever. He subsequently developed poly- Iron deficiency anaemia Aleukaemic stem-celled leukaemia 3 arthritis and a mitral pansystolic murmur. Others (33): Arthritis. 5 Still's Disease. This boy presented with a three months' Arthralgia 9 Limb pains 1519 history of polyarthritis, fever, rash and general malaise. Fever It was not until after 10 weeks in this hospital that he Gout and syphilis 1 heart lesions, by which time the arthritis had developed Total copyright. settled leaving no residua. Fallen Arches. This 6-year-old boy had complained of I. Functional. This group comprised six children pain in his feet for four weeks and had been treated with and two young adults. The three patients with remedial exercises. He developed polyarthritis, and had a physiological tachycardia were all children. The first raised E.S.R. and A.S.O. titre. had a history of recent sore throat and the referring doctor thought he had detected clinical signs of Group B. Unsubstantiated Admission Diagnosis of cardiac enlargement with persistent tachycardia. Rheumatic Fever The second child had complained of limb pains for This group consisted of all patients admitted six weeks and was noted to have an evening tempera- http://adc.bmj.com/ between July, 1947, and October 31, 1956, with the ture up to 98 8°F. and persistent tachycardia of presumed diagnosis of rheumatic fever, but in whom 130-140 per minute. The third child had a recent this diagnosis was not substantiated. Only those history ofcold and cough with persistent tachycardia. were included in whom there was fairly certain Nothing abnormal could be found in any of these evidence from the referring letter or history on entry patients, and, although the pulse rate was elevated that they were thought to have rheumatic fever; they by day, the sleeping pulse was within the normal numbered 196. range (Nelson, 1954). on October 1, 2021 by guest. Protected These 196 admissions consisted of 171 children The two young female adults complained of limb under the age of 17 years, and 25 adults. Follow-up pains and general ill-health; one had had rheumatic has varied from none in a small minority to several fever as a child; she showed hysterical manifestations years in some instances. There has been no evident such as hyperventilation and no organic signs were rheumatic activity at these check-ups, and no patient found. The other patient also had nothing organic has developed organic heart disease under out- demonstrable, and was referred to a psychiatrist patient observation. None of the patients either on who diagnosed neurosis and depression. long or short term follow-up has been re-admitted The other three children all complained of pains with rheumatic fever. They may be divided into seven in joints or limbs for which no organic cause was broad groups which can be further subdivided as found. One had a functional wrist drop, the second shown in Table 1. The various groups will now be hysterical gait, and the third, with an unhappy home considered in more detail: background, admitted to exaggerating his symptoms Arch Dis Child: first published as 10.1136/adc.33.170.350 on 1 August 1958. Downloaded from 352 ARCHIVES OF DISEASE IN CHILDHOOD because of desire for sympathy. All were helped by III. Infections. (a) UPPER RESPIRATORY TRACT psychiatric treatment. INFECTIONS. Of this large group, 45 (43 children and two young adults) were diagnosed as upper respira- ll. Traumatic and Postural. All the patients in this tory tract infections. The presumptive diagnosis of group were children, and all complained of joint rheumatic fever was based on preceding upper pains; three patients had a history of rheumatic fever.
Load more

Recommended publications
  • Rheumatic Fever and Rheumatic Heart Disease
    SEVENTY-FIRST WORLD HEALTH ASSEMBLY A71/25 Provisional agenda item 12.8 12 April 2018 Rheumatic fever and rheumatic heart disease Report by the Director-General 1. In May 2017, the Executive Board, at its 141st session, noted an earlier version of this report1 and adopted resolution EB141.R1 on rheumatic fever and rheumatic heart disease. Paragraphs 15 and 18 in this report contain new text in response to comments from Member States. WHERE DO WE STAND TODAY? 2. Rheumatic heart disease is a preventable yet serious public health problem in low- and middle-income countries and in marginalized communities in high-income countries, including indigenous populations. 3. The disease results from damage to heart valves caused by one or several episodes of rheumatic fever, an autoimmune inflammatory reaction to throat infection caused by group A streptococci (streptococcal pharyngitis). It most commonly occurs in childhood, and can lead to death or life-long disability. Effective early intervention can prevent premature mortality from rheumatic heart disease. 4. Some 30 million people are currently thought to be affected by rheumatic heart disease globally,2 and in 2015 rheumatic heart disease was estimated to have been responsible for 305 000 deaths and 11.5 million disability-adjusted life years lost. Of these deaths 60% occurred prematurely (that is, before the age of 70 years), although these figures are very uncertain owing to incomplete data in many countries. Despite the availability of effective measures for prevention and treatment, there has been little change in the contribution of rheumatic heart disease to overall global mortality between 2000 and 2015.3 5.
    [Show full text]
  • Valvular Heart Disease Acute Rheumatic Fever
    Valvular heart disease Acute rheumatic fever Rheumatic fever • It typically occurs several weeks after streptococcal pharyngitis. • The most common pathogen is group A beta-hemolytic streptococci (GABHS) • Streptococcus cross-react with proteins in cardiac valves. • Time from acute streptococcal infection to onset of symptomatic rheumatic fever (RF) is usually 3–4 weeks. • RF is thought to complicate up to 3% of untreated streptococcal sore throats. • Previous episodes of RF predispose to recurrences. Diagnostic criteria for rheumatic fever (Jones criteria) • Evidence of group A streptococcal pharyngitis • Either a positive throat culture or rapid streptococcal antigen test, or an elevated or rising streptococcal antibody titer (samples taken 2 weeks apart). • Plus two major or one major and two minor Jones criteria: Major criteria Minor criteria • Polyarthritis • Fever • Carditis • Arthralgia • Chorea • Prolonged PR interval • Erythema marginatum • Elevated ESR and CRP • Subcutaneous nodules Joints • Migratory large-joint polyarthritis starting in the lower limbs in 75% of cases. Duration is <4 weeks at each site. There is severe pain and tenderness in contrast to a mild degree of joint swelling. Heart • Pancarditis occurs in 50% of cases with features of acute heart failure, mitral and aortic regurgitation, and pericarditis. • Endocarditis • affects the mitral valve (65%–70%), aortic valve (25%), and tricuspid valve (10%, never in isolation), causing acute regurgitation and heart failure but chronic stenosis. • Pericarditis • Pain • Friction rub • rarely causes hemodynamic instability/tamponade or constriction. Heart Myocarditis • Acute heart failure • Arrhythmias • Most common reason of death Skin • Erythema marginatum is an evanescent rash with serpiginous outlines and central clearings on the trunk and proximal limbs.
    [Show full text]
  • Rheumatic Fever and Rheumatic Heart Disease in Children Below the Age of 5 Years in the Tropics
    Ann Rheum Dis: first published as 10.1136/ard.24.4.389 on 1 July 1965. Downloaded from Ann. rheumn. Dis. (1965). 24, 389. RHEUMATIC FEVER AND RHEUMATIC HEART DISEASE IN CHILDREN BELOW THE AGE OF 5 YEARS IN THE TROPICS BY ZAHIRA H. ABDIN AND A. EISSA From the Rheumatic and Heart Unit, Children's Hospital, Cairo University, Egypt Rheumatic fever and particularly rheumatic heart months. The history and main clinical finding in disease have always been regarded as rare conditions these four cases is given in the footnote below.* below the age of 5 years and as very rare below 3 years The sex distribution was 42 females to 26 males, (Holt and McIntosh, 1953). Reported cases are i.e. 2-4:1 compared to a general incidence of 1 7:1 few and no account of the clinical pattern of the (Table I). disease in the small child has been found in the TABLE I literature. SEX RATIO AND FAMILIAL TENDENCY In the Rheumatic and Heart Clinic, in Cairo Rto Positive Familial University Hospital, we have had the opportunity Group No. of Sex Ratio History* of examining large numbers of children referred with Cases Female:Male (per cent.) rheumatic fever and rheumatic heart disease in the 1. Children below 5 last 4 years. It was thus possible to collect a fairly years .. 68 2-4:1 20-5 copyright. large group of younger children with the disease and II. Children of all ages 1.7:11,000 3 - 5 we were able to examine the incidence as well as the special features of rheumatic fever and rheumatic * X2 82-5.
    [Show full text]
  • Acute Rheumatic Fever and Rheumatic Heart Disease in Resource-Limited Settings
    Downloaded from http://adc.bmj.com/ on April 28, 2017 - Published by group.bmj.com Global child health Acute rheumatic fever and rheumatic heart disease in resource-limited settings Gabriella Watson,1 Bintou Jallow,1 Kirsty Le Doare,1,2 Kuberan Pushparajah,3 Suzanne T Anderson1 ▸ Additional material is ABSTRACT working in resource-limited settings in their diag- published online only. To view Poststreptococcal complications, such as acute rheumatic nosis and management, and approaches for over- please visit the journal online fi (http://dx.doi.org/10.1136/ fever (ARF) and rheumatic heart disease (RHD), are coming some of these dif culties. archdischild-2014-307938). common in resource-limited settings, with RHD recognised as the most common cause of paediatric ACUTE RHEUMATIC FEVER 1Gambia Unit, Medical Research Council, Fajara, heart disease worldwide. Managing these conditions in Case vignette The Gambia resource-limited settings can be challenging. We review A 12-year-old Gambian girl presented to a health 2Wellcome Centre for Global the investigation and treatment options for ARF and centre complaining of lethargy, arthralgia and inter- Health Research, Imperial RHD and, most importantly, prevention methods in an mittent fever. She was diagnosed with clinical College, London, UK 3Department of Congenital African setting. malaria and treated accordingly. Heart Disease, Evelina London Four months later she presented to clinic with Children’s Hospital, Guy’s&St similar symptoms. On examination she looked Thomas’ NHS Foundation INTRODUCTION acutely unwell with a soft systolic murmur in the Trust, London, UK Infections caused by Group A streptococcus (GAS) mitral area. Blood tests showed leukocytosis and a fi Correspondence to were identi ed as the ninth leading cause of global raised erythrocyte sedimentation rate (ESR) of Dr Gabriella Watson, Gambia mortality from an individual pathogen in the 2004 130 mm/h.
    [Show full text]
  • Rheumatic Heart Disease
    put together by Alex Yartsev: Sorry if i used your images or data and forgot to reference you. Tell me who you are. [email protected] Rheumatic Heart Disease History of Presenting Illness - Dyspnoea on exertion or at rest - Nocturnal dyspnoea - Orthopnoea - Swollen ankles4 - “mitral facies” - Palpitations - Chest pain Differential Diagnoses Aortic Stenosis, Valvar Human Immunodeficiency Virus Infection Aortic Valve Insufficiency Kawasaki Disease Aortic Valve, Bicuspid Mitral Stenosis, Congenital Appendicitis Mitral Valve Insufficiency Arthritis, Septic Mitral Valve Prolapse Cardiac Tumors Myocarditis, Viral Cardiomyopathy, Dilated Pericardial Effusion, Malignant Carnitine Deficiency Pericarditis, Bacterial Coccidioidomycosis Pericarditis, Viral Endocarditis, Bacterial Sarcoidosis Heart Failure, Congestive Systemic Lupus Erythematosus Histoplasmosis Transient Synovitis How is this diagnosis made? The Jones criteria require the presence of 2 major or 1 major and 2 minor criteria major diagnostic criteria minor diagnostic criteria - Carditis - fever - Polyarthritis - arthralgia - Chorea - prolonged PR interval on ECG - subcutaneous nodules - elevated ESR or CRP - erythema marginatum - leukocytosis Additional evidence of previous group A streptococcal pharyngitis is required - Positive throat culture or rapid streptococcal antigen test - Elevated or rising streptococcal antibody titer - History of previous rheumatic fever or rheumatic heart disease Pertinent Findings on History - PAST HISTORY OF RHEUMATIC HEART DISEASE: most important. - CHILDHOOD STREP THROAT: school age (peak 5-15years) Findings on Examination CARDIAC MANIFESTATIONS: Rapid irregular pulse!! AF - Pancarditis is the most serious and second most common complication of rheumatic fever (50%). In advanced cases, patients may complain of dyspnea, mild-to-moderate chest discomfort, pleuritic chest pain, edema, cough, or orthopnea. - carditis is most commonly detected by a new murmur and tachycardia out of proportion to fever.
    [Show full text]
  • Rheumatic Fever and Rheumatic Heart Disease 2
    2 Rheumatic fever and rheumatic heart disease from RHD CYAN MAGENTA YELLOW BLACK Deaths from rheumatic heart disease ICELAND 2 Rheumatic fever and FINLAND Number of deaths SWEDEN NORWAY 2002 rheumatic heart disease ESTONIA RUSSIAN 10 000 and above 500–999 0–9 UNITED LATVIA FED. KINGDOM Rheumatic fever usually follows DENMARK LITHUANIA 5000–9999 100–499 no data an untreated beta-haemolytic IRELAND NETH. BELARUS POLAND streptococcal throat infection in BELGIUM GERMANY 1000–4999 10–99 CZECH UKRAINE REPUBLIC SLOVAKIA children. It can affect many parts LUX. REP. HUNGARY MOLDOVA AUSTRIA ROMANIA of the body, and may result in FRANCE SWITZ. SLOVENIA BOSNIA & S. MARINO HERZEGOVINA rheumatic heart disease, in which CANADA CROATIA SERBIA & BULGARIA RUSSIAN FEDERATION MONTENEGRO ANDORRA MONACO ITALY the heart valves are permanently If treated, ALBANIA PORTUGAL FYR MACEDONIA damaged, and which may progress 75% of people SPAIN to heart failure, atrial fibrillation, with rheumatic GREECE fever recover KAZAKHSTAN and embolic stroke. MALTA MONGOLIA completely. Nowadays, rheumatic fever U S A DPR GEORGIA UZBEKISTAN KYRGYZSTAN KOREA JAPAN ARMENIAAZERBAIJAN mostly affects children in TURKEY TURKMENISTAN REP. TAJIKISTAN KOREA developing countries, especially CYPRUS SYRIAN ARAB TUNISIA REPUBLIC CHINA MOROCCO LEBANON AFGHANISTAN where poverty is widespread. Up ISRAEL IRAQ ISL. REP. JORDAN IRAN MARSHALL ISLANDS to 1% of all schoolchildren in KUWAIT PAKISTAN BHUTAN KIRIBATI BAHAMAS ALGERIA LIBYAN NEPAL CUBA ARAB BAHRAIN QATAR Africa, Asia, the Eastern MEXICO JAMAHIRIYA NAURU EGYPT UAE BANGLADESH TUVALU Mediterranean region and Latin DOMINICAN SAUDI ARABIA INDIA JAMAICA REP. MYANMAR LAO BELIZE HAITI PDR SAMOA COOK MAURITANIA OMAN VIET NAM America show signs of the ST KITTS & NEVIS ANTIGUA & BARBUDA ISLANDS GUATEMALA HONDURAS MALI FIJI DOMINICA CAPE VERDE NIGER THAILAND VANUATU EL SALVADOR ST VINCENT & GRENADINES SENEGAL ERITREA YEMEN disease.
    [Show full text]
  • What About My Child and Rheumatic Fever? (PDF)
    ANSWERS Cardiovascular Conditions by heart What About My Child and Rheumatic Fever? Rheumatic fever is an inflammatory reaction that can occur after a streptococcal infection of the throat (“strep throat”). Most strep throat infections don’t lead to rheumatic fever. When they do, the time between the strep throat and rheumatic fever is about two to four weeks. Rheumatic fever is not contagious; however, the strep infection that comes before it is. If a strep throat infection is treated, rheumatic fever can almost always be prevented. Anyone can get rheumatic fever, but those who do are often 5 to 15 years old. What are the common symptoms of strep Symptoms can vary widely, but may include: throat? • Fever Symptoms of strep throat include (but are not limited to): • Painful, tender, red, swollen joints • Sudden onset of a sore throat • Shortness of breath • Pain on swallowing • Skin rashes, especially on the chest or abdomen • Fever (usually 101-104°F) • Bumps under the skin • Headache • Abdominal pain, nausea, and vomiting, especially in Does it always affect the heart? children No. When it does, the damage may either disappear or remain. When rheumatic fever causes permanent heart The symptoms may be mild in some children. If your damage, it’s called rheumatic heart disease. child has a sore throat, you can’t know for sure if it’s strep throat unless you take him or her to a doctor. Is there a cure for it? How does rheumatic fever affect the body? There’s no “miracle drug” to cure it. An attack of rheumatic fever usually subsides within a few weeks to It may affect many parts of the body.
    [Show full text]
  • Rheumatic Heart Disease Lakshmi Vasudha*
    Short Communication 2020 iMedPub Journals www.imedpub.com DOI: 10.36648/2471-8157.6.4.e104 Rheumatic Heart Disease Lakshmi Vasudha* Department of Microbiology, Andhra University, Vishakhapatnam, India. Received: November 15, 2020; Accepted: November 23, 2020; Published: November 28, 2020 *Corresponding author: Dr. Lakshmi Vasudha Abstract [email protected] Rheumatic heart disease is a condition in which the heart valves have been permanently damaged by rheumatic fever. Rheumatic Department of Microbiology, Andhra fever is an inflammatory disease that can affect many connective University, Vishakhapatnam, India. tissues, especially in the heart. Untreated or under-treated strep infections put a person at increased risk. Citation: Vasudha L (2020) Scope of What causes rheumatic heart disease? Rheumatic heart disease Interventional Cardiology Journal. Interv is caused by rheumatic fever, an inflammatory disease that can Cardiol J Vol.6 No.4:e104 affect many connective tissues, especially in the heart, joints, skin, or brain. The heart valves can be inflamed and become scarred over time Rheumatic fever, an inflammatory disease, can affect many Key words: Rheumatic, Heart Disease connective tissues, especially in the heart, joints, skin, or brain. INTRODUCTION The infection often causes heart damage, particularly scarring of the heart valves, forcing the heart to work harder to pump blood. The relative survival was 96.9% (95% CI 96.1–97.5%) at one year It is not clear why some people who are infected with group A and 81.2% (95% CI 79.2–83.0%) at five years (S3 Fig). The risk of Streptococcus bacteria go on to develop rheumatic fever, while death among RHD/ARF patients increased with age over and above background rates; there was also increased risk for both others do not; however, it appears that some families may have male and intake patients.
    [Show full text]
  • Rheumatic Endocarditis
    University of Nebraska Medical Center DigitalCommons@UNMC MD Theses Special Collections 5-1-1938 Rheumatic endocarditis Roy F. Pierson University of Nebraska Medical Center This manuscript is historical in nature and may not reflect current medical research and practice. Search PubMed for current research. Follow this and additional works at: https://digitalcommons.unmc.edu/mdtheses Part of the Medical Education Commons Recommended Citation Pierson, Roy F., "Rheumatic endocarditis" (1938). MD Theses. 690. https://digitalcommons.unmc.edu/mdtheses/690 This Thesis is brought to you for free and open access by the Special Collections at DigitalCommons@UNMC. It has been accepted for inclusion in MD Theses by an authorized administrator of DigitalCommons@UNMC. For more information, please contact [email protected]. .RHEUKATIC ENDOCARDITIS Boy :r. Pieraon SENIOR THESIS PRESENTED TO - THE UNIVERSITY OF NEBR. COLLEGE OF llmDICINE Olt:AHA, 1938 INDEX· DEFINITION 1 I NT RODUCTI ON 2 HISTORY 3 INCIDENCE 15 ETIOLOGY 26 PATHOLOGY 36 SYMPTOMS AND DIAGNOSIS 59 TREATMENT 70 BIBLIOGRAPHY 80 480967 DEFINITION Bbeumatic Endocarditis is an inflammat­ ory disease of the endoeardium associated with :Rheumatic Fever. The disease process is charact­ erized by its indefinitely prolonged febrile course, a tendeney toward relapses, arthritic and nervous manifestations, •ubcutaneous nodules and changes in the endoeardium and myoeardium which are dependent upon the extensiveness of involvement. -l- .......... INTRODUCTION Rb.eumatie Endoearditia and its innocent counterpart, Hleuma.tic Fever have been associated since Piteairn first described this condition in 1788. Since that time they have been a most consp­ icuous thorn in the palm of the medical hand. For to this day, their origin has been concealed from the most discriminating minds of the profession.
    [Show full text]
  • CVDY Rheumatic Fever, Endocarditis and Kawasaki Disease Committee
    COMMISSION Rheumatic Fever, Endocarditis and Kawasaki Disease Committee Council on Lifelong Congenital Heart Disease and Heart Health in the Young (Young Hearts) NUMBER OF MEMBERS: 15 members. METHOD OF APPOINTMENT: The Council Chair, in consultation with the Committee Chair and Nominating Committee, shall appoint Committee members. The Committee shall be made up of a Chair and 8-10 members drawn from the Council (1-2 members from the Council on Clinical Cardiology (CLCD)), as well as external Liaisons from the AAP, IDSA, and ADA. TERM OF OFFICE: Members shall serve two-year terms beginning July 1st and ending June 30th and shall be staggered for continuity. FREQUENCY OF MEETINGS: The Committee shall meet face-to-face twice per year, in the Fall in conjunction with AHA Scientific Sessions, and in the Spring in conjunction with ACC. The time commitment will vary, but should not exceed 1-3 hours per month. RESPONSIBILITIES: Committee Responsibilities: • Review and evaluate new medical/scientific knowledge in the field of cardiac infectious diseases – particularly rheumatic fever, infective endocarditis, and Kawasaki disease; • Prepare scientific statements on the prevention and treatment of infective endocarditis in both children and adults; • Prepare scientific statements on the treatment of streptococcal pharyngitis and prevention of rheumatic fever; and update the Jones criteria at regular intervals; • Prepare scientific statements on the diagnosis and acute and long-term management of patients with Kawasaki disease; • Stimulate development and accumulation of further knowledge in the field; • Develop scientific conferences related to these infectious diseases; • Furnish guidance for educational matters related to these diseases; • Participate in AHA scientific conferences, and/or prepare booklets, pamphlets, and other material for the public.
    [Show full text]
  • A Sore Throat Can Hurt Your Heart Pay Close Attention to a Sore Throat
    A SOre THROat CAN HURT YOUR HEART Pay close attention to a sore throat. A dangerous disease with devastating effects on the heart could be at work. By Carine Visagie ost people accept the occasional sore HOW RHEUMATIC FEVER CAN LEAD throat as a normal part of life. After all, it’s TO RHEUMATIC HEART DISEASE one of those bothersome symptoms that often A link between a sore throat and heart disease may seem accompany a harmless cold. But if a sore throat unlikely, but it all comes down to inflammation in the body is caused by a specific group of bacteria, heart and an ongoing, damaging immune response. OCK T S Mdamage may follow. When a sore throat caused by group A streptococcus I S, Rheumatic fever, the inflammatory disease that may bacteria is left untreated, the ongoing inflammation can set E G A M develop after so-called ‘strep throat’, can cause rheumatic off an ‘immune cascade’ in the body, explains Dr Liesl Zühlke, I heart disease – a deadly condition that kills more than 1 000 paediatric cardiologist at the Red Cross War Memorial LLO A people worldwide every day. In South Africa, it’s the leading Children’s Hospital in Cape Town. Your antibodies start Y/G cause of acquired heart disease in children and young adults, to repeatedly attack other organs and tissues, and the heart, ett and the sixth highest cause of death due to heart disease. joints, skin and central nervous system may be affected. This G Could you or your child be at risk? Brush up on the facts.
    [Show full text]
  • Case Report and Review of the Literature
    Relato de Caso Miocardite Clinicamente Manifesta em Surto Agudo de Febre Reumática Clinically Manifested Myocarditis in Acute Rheumatic Fever José L. Xavier Jr.1, Alexandre de Matos Soeiro1, Antonio S. S. A. Lopes2, Guilherme S. Spina2, Carlos V. Serrano Jr.1, Múcio T. Oliveira Jr.1 Unidade Clínica de Emergência - Instituto do Coração (InCor) - HCFMUSP1; Unidade Clínica de Valvopatias - Instituto do Coração (InCor) - HCFMUSP2, São Paulo, SP - Brasil Introdução realizou cintilografia miocárdica pré-operatória com gálio-67, O desenvolvimento de miocardite aguda em período que resultou negativa para processo inflamatório miocárdico. pós-operatório de cirurgia cardíaca é um desafio para o médico A cirurgia decorreu sem complicações, e o ecocardiograma que cuida desse tipo de paciente. Na maioria das vezes, a transtorácico pós-operatório mostrava átrio esquerdo (AE) de miocardite pode ser apenas consequência da inflamação 50 mm de diâmetro, ventrículo esquerdo (VE) de 56 × 39 mm, relacionada ao procedimento. No entanto, diagnósticos fração de ejeção (FE) de 57% e prótese biológica mitral sem diferenciais devem ser observados. Dentre eles, a febre reumática alterações estruturais. Recebeu alta em uso das medicações entra como importante mecanismo. Apesar de sua manifestação citadas anteriormente. cardíaca predominante relacionar-se ao acometimento do Ao exame físico, apresentava-se em regular estado geral, afebril, aparato valvar, seu diagnóstico é essencialmente clínico, e ela taquicárdica (frequência cardíaca = 180 batimentos por minuto), pode comprometer agudamente o miocárdio. Nesse contexto, a pressão arterial de 90 × 60 mmHg, taquidispneica (frequência ocorrência de miocardite reumática aguda é rara e de tratamento respiratória = 25 incursões por minuto), com saturação arterial de imunossupressor ainda incerto.
    [Show full text]