Novelties in acute rheumatic fever – Review

Abstract

While the incidence and importance of acute rheumatic fever has been declining in industrialized countries it remains as the most important cause of acquired heart disease in developing or undeveloped countries About 3 to 6 of any population is considered to be susceptible to rheumatic fever Although it is common between the ages of 5 and 15 the patients under five years comprise 3 5 of the total number Acute rheumatic fever is diagnosed using the Jones criteria updated by the World Health Organization in 2003 During the first attack two major or one major two minor manifestations in the presence of evidence of recent streptococcal throat infection is a high probability of rheumatic fever Major manifestations are migratory polyarthritis carditis chorea erythema marginatum and subcutaneous nodules; minor manifestations are fever over 38ºC arthralgia elevated acute phase reactants ESR gt;60mm hr C reactive protein and prolongation of PR interval on electrocardiogram Positive throat culture for streptococci elevated increasing ASO titers and history of scarlet fever are accepted as evidences of recent streptococcal infection The role of echocardiography has increased in recent years When echocardiography is not performed subclinical valvular involvements are not recognized and these patients may present with rheumatic heart disease in the future Bed chair rest antibiotic treatment anti inflammatory treatment the treatment for congestive heart failure and sedation in patients with chorea are options for management of rheumatic fever The only intervention proven to affect long term prognosis is secondary prophylaxis In conclusion rheumatic fever may present in various appearances and still bites the heart Turk Arch Ped 2007; 42: 85 93 Key words: Acute rheumatic fever rheumatic heart disease Jones criteria

Keywords

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Akut romatizmal ateş ve yenilikler Derleme

Öz

Akut romatizmal ateş gelişmiş ülkelerde sıklığı ve önemi giderek azalmakla birlikte az gelişmiş ve gelişmekte olan ülkelerde hala edinilmiş kalp hastalıklarının en önemli nedenini oluşturmaktadır Herhangi bir toplumun 3 6’sının romatizmal ateşe duyarlı olduğu düşünülmektedir En sık 5 15 yaş arasında görülmekle birlikte beş yaş altındaki olgular toplam sayının 3 5’ini oluşturmaktadır Tanı son olarak 2003 yılında Dünya Sağlık Örgütünce yeniden gözden geçirilen Jones ölçütleri ile konulmaktadır İlk atak sırasında geçirilmiş streptokok enfeksiyonu kanıtlandığında iki majör ya da bir majör iki minör bulgunun birlikte bulunması romatizmal ateş tanısı için yüksek bir olasılıktır Majör bulgular gezici poliartrit kardit kore eritema marjinatum ve deri altı nodüller; minör bulgular ise 38 derecenin üzerinde ateş artralji akut faz belirteçlerinde artış eritrosit çökme hızı gt;60mm sa C reaktif protein ve elektrokardiyogramda PR aralığının uzamasıdır Boğaz kültüründe etkenin üretilmesi yüksek artan ASO titresi kızıl öyküsü geçirilmiş streptokok enfeksiyonu kanıtı olarak kabul edilir Ekokardiyografinin tanıdaki rolü son yıllarda giderek artmıştır Ekokardiyografi uygulanmadığında “subklinik” kapak yetersizlikleri atlanmakta ileride romatizmal kapak hastalığı olarak karşımıza çıkabilmektedir Yatak istirahati antibiyotik tedavisi antienflamatuvar tedavi kalp yetersizliği tedavisi kore’li hastalarda sedasyon ve cerrahi tedavi seçenekleri mevcuttur Hastalığın seyrini değiştirdiği düşünülen tek girişim ikincil profilaksidir Sonuç olarak akut romatizmal ateş değişik kılıklarda karşımıza çıkabilen ve ‘kalbi ısıran’ bir hastalık olma özelliğini sürdürmektedir Türk Ped Arş 2007; 42: 85 93 Anahtar kelimeler: Akut romatizmal ateş romatizmal kalp hastalığı Jones ölçütleri

Anahtar Kelimeler

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Kaynakça

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