📋 Paediatrics
Acute Rheumatic Fever in Children Causes Symptoms Diagnosis Treatment Prevention
Acute Rheumatic Fever in children is an autoimmune inflammatory disease that develops after untreated streptococcal throat infection. Learn detailed causes, pathophysiology, symptoms, Jones criteria, diagnosis, investigations, treatment, complications, and prevention of rheumatic heart disease in paediatrics.
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Frequently Asked Questions
❓ What is acute rheumatic fever in children?
Acute rheumatic fever is an autoimmune inflammatory disease that develops after untreated or inadequately treated group A beta hemolytic streptococcal throat infection. It commonly affects children aged 5 to 15 years and can involve the heart, joints, skin, and central nervous system.
❓ What causes acute rheumatic fever in children?
Acute rheumatic fever is caused by an abnormal immune response to infection with group A beta hemolytic Streptococcus pyogenes. Antibodies produced against streptococcal antigens cross react with human tissues such as the heart valves, joints, brain, and skin, leading to inflammation.
❓ What are the common symptoms of acute rheumatic fever in children?
Common symptoms include fever, migratory joint pain affecting large joints, carditis with heart murmurs, involuntary movements known as Sydenham chorea, skin rash called erythema marginatum, and painless subcutaneous nodules.
❓ What are the Jones criteria used for diagnosing rheumatic fever?
The Jones criteria are clinical guidelines used to diagnose acute rheumatic fever. Major criteria include carditis, migratory polyarthritis, Sydenham chorea, erythema marginatum, and subcutaneous nodules. Minor criteria include fever, arthralgia, elevated ESR or CRP, and prolonged PR interval. Evidence of recent streptococcal infection is also required.
❓ Which heart valve is most commonly affected in rheumatic fever?
The mitral valve is the most commonly affected valve in acute rheumatic fever, leading to mitral regurgitation initially and possibly mitral stenosis later in chronic rheumatic heart disease.
❓ How is acute rheumatic fever treated in children?
Treatment includes eradication of streptococcal infection with benzathine penicillin G, anti inflammatory therapy such as aspirin or corticosteroids for severe carditis, management of heart failure if present, and long term antibiotic prophylaxis to prevent recurrence.
❓ What is secondary prophylaxis in rheumatic fever?
Secondary prophylaxis refers to long term antibiotic therapy, usually with intramuscular benzathine penicillin every 3 to 4 weeks, to prevent recurrent streptococcal infections and further episodes of rheumatic fever.
❓ How long should secondary prophylaxis be given for rheumatic fever?
If there is no carditis, prophylaxis should continue for 5 years or until age 21. If carditis occurred without residual heart disease, it should continue for 10 years or until age 21. If persistent valvular disease exists, prophylaxis may continue until age 40 or lifelong.
❓ What complications can occur from acute rheumatic fever?
The most serious complication is rheumatic heart disease, which causes permanent damage to heart valves. Other complications include heart failure, arrhythmias, and recurrent episodes of rheumatic fever.
❓ How can acute rheumatic fever be prevented in children?
Primary prevention involves early diagnosis and proper antibiotic treatment of streptococcal throat infections. Secondary prevention involves long term penicillin prophylaxis to prevent recurrence and progression to rheumatic heart disease.