Rheumatic fever is an immune disease systemic (whole body) that occurs as a result of infection by bacteria of the family of the coconuts.
What causes it?
This condition, as mentioned above is caused by hemolytic streptococcus B. And it can cause a slow, progressive deformation of the valves or can heal spontaneously. It is more frequent between 5 and 15 years of age and is rare before age 4 and after age 40. The characteristic lesion is a perivascular granulomatous reaction with vasculitis.
The mitral valve is attacked by 75 to 80% of the cases, 30% aortic and tricuspid and pulmonary valves in less than 5%.
1. Carditis: is more likely to be observed in children and adolescents and is characterized by pericarditis, cardiomegalea, right or left heart failure (the first is most notable in children for painful liver engorgement tricuspid regurgitation), mitral murmurs a0ticos regurgitation ( mitral murmur can be no short-Coombs mesodiastolico Carrey). If you do not find well-defined above signs, the diagnosis of carditis is set to less specific the following abnormalities: electrocardiographic abnormalities, heart sounds that change in quality, sinus tachycardia that persists during sleep and increases significantly during light activity and arrhythmias.
2. Erythema marginatum and subcutaneous nodules: the first is presented as a stain (wheal) is fast growing or decreasing ring-shaped with clear center. May be raised, confluent, transient or persistent.
Subcutaneous nodules are rare except in children and has a diameter of 2 cm or less, are hard, not painful and are fixed to the fascia or tendon sheath over bony prominences
3. Sydenham’s chorea: It is less common manifestation (3%) but is the most significant of rheumatic fever. It may also be the only manifestation and most often affects children and less common in adults.
4. ATRITIS: Attacks large joints sequentially and is a migratory polyarthritis. (Adults may attack only one joint). This sign in the acute form usually lasts from 1 to 5 weeks and refers without leaving deformities.
Include fever, polyarthralgias, reversible prolongation of the PR interval, accelerated erythrocyte sedimentation rate, evidence of a history of B-hemolytic streptococcal infection or a history of rheumatic fever.
To set this need to meet several criteria that are divided into major and minor. So that with two major criteria or one major and one minor is established. (See symptoms).
Laboratory for diagnostic evidence enferemedad nonspecific inflammatory as the rate of sedimentation. Titles are also used high or rising antibody antistreptococcal particularly antistreptolysin O (ASO) to confirm a recent infection in 10% of cases there is no serological test.
TREATMENT AND RECOMMENDATIONS
Treatment of rheumatic fever is divided into medical measures, general measures and prevention.
MEDICAL ACTION: For the management of fever, pain and joint swelling salicitatos are recommended. Although these have no action on the evolution of the disease.
Penicillin should utizarse to eradicate the streptococcus if it exists.
Corticosteroids are often used when the response to salicylates has been inadequate, and these drugs are rapid improvement but its use should be brief.
GENERAL MEASURES: The patient must complete bed rest in bed until the temperature returns to normal without medication, and the sedimentation rate, pulse rate at rest and ECG return to baseline image.
PREVENTION OF RECURRENT RHEUMATIC FEVER: prevention is carried out with penicillin G benzathine 1.2 million units IM every four weeks and is recommended especially for children who have suffered one or more acute attacks. This scheme should be carried out every year until they turn 25 years old. In adults apply for 5 years after an attack