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1、RheumaticFever05/05/1999Dr.SaidAlavi2EtiologyAcuterheumaticfeverisasystemicdiseaseofchildhood,oftenrecurrentthatfollowsgroupAbetahemolyticstreptococcalinfectionItisadelayednon-suppurativesequelaetoURTIwithGABHstreptococci.Itisadiffuseinflammatorydiseaseofconnectivet
2、issue,primarilyinvolvingheart,bloodvessels,joints,subcut.tissueandCNS05/05/1999Dr.SaidAlavi3EpidemiologyAges5-15yrsaremostsusceptibleRare<3yrsGirls>boysCommonin3rdworldcountriesEnvironmentalfactors--overcrowding,poorsanitation,poverty,Incidencemoreduringfall,winter&
3、earlyspring05/05/1999Dr.SaidAlavi4PathogenesisDelayedimmuneresponsetoinfectionwithgroup.Abetahemolyticstreptococci.Afteralatentperiodof1-3weeks,antibodyinducedimmunologicaldamageoccurtoheartvalves,joints,subcutaneoustissue&basalgangliaofbrain05/05/1999Dr.SaidAlavi5S
4、trainsthatproducesrheumaticfever-Mtypesl,3,5,6,18&24Pharyngitis-producedbyGABHScanleadto-acuterheumaticfever,rheumaticheartdisease&poststrept.GlomerulonepritisSkininfection-producedbyGABHSleadstopoststreptococcalglomerulonephritisonly.ItwillnotresultinRh.Feverorcard
5、itisGroupABetaHemolyticStreptococcus05/05/1999Dr.SaidAlavi6ClinicalFeaturesMigratorypolyarthritis,involvingmajorjointsCommonlyinvolvedjoints-knee,ankle,elbow&wristOccurin80%,involvedjointsareexquisitelytenderInchildrenbelow5yrsarthritisusuallymildbutcarditismoreprom
6、inentArthritisdonotprogresstochronicdisease1.Arthritis05/05/1999Dr.SaidAlavi7ClinicalFeatures(Contd)Manifestaspancarditis(endocarditis,myocarditisandpericarditis),occurin40-50%ofcasesCarditisistheonlymanifestationofrheumaticfeverthatleavesasequelae&permanentdamageto
7、theorganValvulitisoccurinacutephaseChronicphase-fibrosis,calcification&stenosisofheartvalves.2.Carditis05/05/1999Dr.SaidAlavi8ClinicalFeatures(Contd)Occurin5-10%ofcasesMainlyingirlsof1-15yrsageMayappeareven6monthsaftertheattackofrheumaticfeverClinicallymanifestas-cl
8、umsiness,deteriorationofhandwriting,emotionallabilityorgrimacingofface3.SydenhamChorea05/05/1999Dr.SaidAlavi9ClinicalFeatures(Contd)Occuri
