Rheumatic fever is caused by a delayed immune response to group A beta-hemolytic streptococcal infection. It primarily affects the heart, joints, subcutaneous tissue, and brain. It is more common in developing countries and affects children between 5-15 years old. Symptoms include arthritis, carditis, Sydenham's chorea, subcutaneous nodules, and erythema marginatum. Diagnosis is based on modified Jones criteria and treatment involves antibiotics, anti-inflammatories, and long-term prevention of recurrent infections.

1. RHEUMATIC FEVER PRESENTED BY ADNAN AHMED BHUTTO Hamdard University Karachi, Pakistan 05/22/10

7. 05/22/10 Diagrammatic structure of the group A beta hemolytic streptococcus Cytoplasm Cyto.membrane Peptidoglycan Group carbohydrate Protein antigens Cell wall Capsule Antigen of outer protein cell wall of GABHS induces antibody response in victim which result in autoimmune damage to heart valves, sub cutaneous tissue,tendons, joints & basal ganglia of brain

9. Rheumatic Carditis Histology 05/22/10

10. Histology of Myocardium in Rheumatic Carditis 05/22/10

12. 05/22/10 Showing ARTHIRITIS In knee joint

15. 05/22/10 Rheumatic heart disease . Abnormal mitral valve. Thick, fused chordae

16. 05/22/10 Another view of thick and fused mitral valves in Rheumatic heart disease

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30. 05/22/10 STEP I : Primary Prevention of Rheumatic Fever (Treatment of Streptococcal Tonsillopharyngitis) Agent Dose Mode Duration Benzathine penicillin G 600 000 U for patients Intramuscular Once 27 kg (60 lb) 1 200 000 U for patients >27 kg or Penicillin V Children: 250 mg 2-3 times daily Oral 10 d (phenoxymethyl penicillin) Adolescents and adults: 500 mg 2-3 times daily For individuals allergic to penicillin Erythromycin: 20-40 mg/kg/d 2-4 times daily Oral 10 d Estolate (maximum 1 g/d or Ethylsuccinate 40 mg/kg/d 2-4 times daily Oral 10 d (maximum 1 g/d)

31. Step II: Anti inflammatory treatment 05/22/10 Clinical condition Drugs

33. 05/22/10 STEP IV : Secondary Prevention of Rheumatic Fever (Prevention of Recurrent Attacks) Agent Dose Mode Benzathine penicillin G 1 200 000 U every 4 weeks* intramuscular or Penicillin V 250 mg twice daily Oral or Sulfadiazine 0.5 g once daily for patients 27 kg (60 lb Oral 1.0 g once daily for patients >27 kg (60 lb) For individuals allergic to penicillin and sulfadiazine Erythromycin 250 mg twice daily Oral *In high-risk situations, administration every 3 weeks is justified and recommended

34. 05/22/10 Duration of Secondary Rheumatic Fever Prophylaxis Category Duration Rheumatic fever with carditis and At least 10 y since last residual heart disease episode and at least until (persistent valvar disease * ) age 40 y, sometimes lifelong prophylaxis Rheumatic fever with carditis 10 y or well into adulthood, but no residual heart disease whichever is longer (no valvar disease*) Rheumatic fever without carditis 5 y or until age 21 y, whichever is longer *Clinical or echocardiographic evidence.

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