Medical history (history of illness) represents an important component in the diagnosis of rheumatic fever. Family history What is the general health of your family members? Are there any diseases in your family that are common? Social history What is your profession? Current medical history/systemic history (somatic and psychological complaints). What symptoms have you noticed? … Rheumatic Fever: Medical History
Blood, blood-forming organs – immune system (D50-D90). Löfgren’s syndrome – subtype of sarcoidosis; characteristic triad (simultaneous appearance of three symptoms): erythema (synonyms: nodular erythema, dermatitis contusiformis, erythema contusiforme; plural: erythemata nodosa; granulomatous inflammation of the subcutis (subcutaneous fat tissue), also known as panniculitis, and a painful nodule (red to blue-red color; later brownish). The overlying … Rheumatic Fever: Or something else? Differential Diagnosis
The following are the most important diseases or complications that may be contributed to by rheumatic fever: Cardiovascular system (I00-I99) Rheumatic valvular heart disease – valvular stenosis (narrowing) or insufficiency (weakness) of all heart valves is possible: Mitral valve affected in 80% of cases. Aortic valve in about 20% of cases Note: Patients with valvular … Rheumatic Fever: Complications
One to three weeks after the preceding streptococcal infection, characteristic symptoms appear that are classified into “major criteria” and “minor criteria” according to Jones. The diagnosis of rheumatic fever can be made if two major criteria or one major and two minor criteria are present. Jones criteria of the American Heart Association (AHA) Major criteria … Rheumatic Fever: Classification
A comprehensive clinical examination is the basis for selecting further diagnostic steps: General physical examination – including blood pressure, pulse, body temperature, body weight, body height; furthermore: Inspection (viewing). Skin [due topossible symptoms: Erythema anulare rheumaticum marginatum (in circa 10%) – truncal circular (segmental), bluish to pale red skin redness. Erythema nodosum (nodular erythema), localization: … Rheumatic Fever: Examination
1st order laboratory parameters – obligatory laboratory tests. Small blood count Blood sedimentation rate (ESR) Inflammatory parameters – CRP (C-reactive protein) or PCT (procalcitonin). Pathogen detection from the infected regions (throat swab). Streptococcal antibodies Antistreptolysin O (ASL) Anti-deoxyribonuclease B (ASNB)
Therapeutic target Elimination of streptococcal infection. Therapy recommendations Antibiosis (antibiotic therapy:oral penicillins, at least 10 days). Anti-inflammatory (anti-inflammatory) therapy (non-steroidal anti-inflammatory drugs (NSAIDs): therapy duration 4 to 6 weeks); if necessary, also analgesics / painkillers (according to the WHO scheme for pain therapy; see below “Chronic pain“) in case of pronounced pain symptoms. Relapse prophylaxis … Rheumatic Fever: Drug Therapy
Optional medical device diagnostics – depending on the results of the history, physical examination, laboratory diagnostics, and obligatory medical device diagnostics – for differential diagnostic clarification. Radiographs of the affected joints Electrocardiogram (ECG; recording of the electrical activity of the heart muscle) [minor criterion: prolonged PQ or PR time]. Echocardiography (echo; cardiac ultrasound) – if … Rheumatic Fever: Diagnostic Tests
1st order Focal rehabilitation (tonsillectomy, dental rehabilitation) in the free interval.
The following symptoms and complaints may indicate rheumatic fever: Fever Headache Sweating The manifestations of rheumatic fever usually occur circa one to three weeks after an upper respiratory tract infection (pharyngitis (pharyngitis), tonsillitis (tonsillitis) or similar). The following manifestations of rheumatic fever are possible: Skin and subcutaneous (L00-L99). Erythema anulare rheumaticum marginatum (in circa 10%) … Rheumatic Fever: Symptoms, Complaints, Signs
Pathogenesis (development of disease) Rheumatic fever refers to a specific infection-induced autoimmune reaction triggered by toxins from serogroup A streptococci. Etiology (Causes) Biographic causes Genetic burden: The risk of developing rheumatic fever after infection with group A β-hemolytic streptococci is influenced by a gene variant for the immunoglobulin long chain. Disease-related causes Respiratory system (J00-J99) … Rheumatic Fever: Causes
General measures Observance of the general hygiene measures! In the occurrence of fever: Bed rest and physical rest (even with only a slight fever). Fever below 38.5 °C does not necessarily need to be treated! (Exceptions: Children prone to febrile convulsions; old, weakened people; patients with a weakened immune system). In case of fever from … Rheumatic Fever: Therapy
