Rheumatic fever natural history, complications, and prognosis: Difference between revisions
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==Overview== | ==Overview== | ||
If left untreated, | If left untreated, patients with rheumatic fever may progress to develop [[arrhythmia]]s, systemic [[embolism|emboli]], and [[endocarditis]], which may lead to [[cardiac failure]]. Common complications of rheumatic fever include [[stenosis]], [[carditis]], and [[stroke]]. Prognosis is generally poor if left untreated. | ||
==Natural History== | ==Natural History== | ||
If an individual develops rheumatic fever, they will experience the development of increased sensitization to [[Streptococcus pyogenes]] autoantigens. | If left untreated, rheumatic fever may cause valvular diseases including [[stenosis]], [[regurgitation]] of mitral/aortic valves and [[myocarditis]]. This may lead to decreased [[cardiac output]], [[pulmonary edema]] and ultimately [[cardiac failure]]. If an individual develops rheumatic fever, they will experience the development of increased sensitization to ''[[Streptococcus pyogenes]]'' autoantigens. Future infection will likely cause an elevated, autoimmunological response and a more severe case of rheumatic fever will develop. | ||
It is estimated that the recurrence rate of rheumatic fever is decreased by about 85% by providing prophylactic [[penicillin]] therapy. Recurrence rate of 0.2/patient/year follow-up was noted among those not receiving regular treatment.<ref name="pmid3700577">{{cite journal| author=Majeed HA, Yousof AM, Khuffash FA, Yusuf AR, Farwana S, Khan N| title=The natural history of acute rheumatic fever in Kuwait: a prospective six year follow-up report. | journal=J Chronic Dis | year= 1986 | volume= 39 | issue= 5 | pages= 361-9 | pmid=3700577 | doi= | pmc= | url= }} </ref> | |||
==Complications== | ==Complications== | ||
Complications to rheumatic fever include: | Complications to rheumatic fever include:<ref name="pmid3700577">{{cite journal| author=Majeed HA, Yousof AM, Khuffash FA, Yusuf AR, Farwana S, Khan N| title=The natural history of acute rheumatic fever in Kuwait: a prospective six year follow-up report. | journal=J Chronic Dis | year= 1986 | volume= 39 | issue= 5 | pages= 361-9 | pmid=3700577 | doi= | pmc= | url= }} </ref><ref name=WHO> Rheumatic Fever and Rheumatic Heart Disease. World Health Organization (2004). http://www.who.int/cardiovascular_diseases/resources/en/cvd_trs923.pdf Accessed on October 12, 2015. </ref><ref name="pmid15686775">{{cite journal| author=Garg N, Kandpal B, Garg N, Tewari S, Kapoor A, Goel P et al.| title=Characteristics of infective endocarditis in a developing country-clinical profile and outcome in 192 Indian patients, 1992-2001. | journal=Int J Cardiol | year= 2005 | volume= 98 | issue= 2 | pages= 253-60 | pmid=15686775 | doi=10.1016/j.ijcard.2003.10.043 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15686775 }} </ref><ref name="pmid16253886">{{cite journal| author=Carapetis JR, Steer AC, Mulholland EK, Weber M| title=The global burden of group A streptococcal diseases. | journal=Lancet Infect Dis | year= 2005 | volume= 5 | issue= 11 | pages= 685-94 | pmid=16253886 | doi=10.1016/S1473-3099(05)70267-X | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16253886 }} </ref> | ||
*[[Mitral stenosis]] | *[[Mitral stenosis]] | ||
*[[Aortic stenosis]] | *[[Aortic stenosis]] | ||
*[[Endocarditis]] | *[[Endocarditis]] | ||
*[[ | *[[Myocarditis]] | ||
*[[Pericarditis]] | |||
*[[Cardiac failure]] | *[[Cardiac failure]] | ||
*[[Arrhythmias]] | *[[Arrhythmias]] | ||
*Systemic | *Systemic [[embolism|emboli]] | ||
*[[ | *[[Stroke]] | ||
*[[Sydenham chorea]] | *[[Sydenham chorea]] | ||
*Recurrence of rheumatic fever | *Recurrence of rheumatic fever |
Revision as of 18:07, 16 October 2015
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Lance Christiansen, D.O.; Associate Editor(s)-in-Chief: Cafer Zorkun, M.D., Ph.D. [2]; Varun Kumar, M.B.B.S. [3]; Anthony Gallo, B.S. [4]
Overview
If left untreated, patients with rheumatic fever may progress to develop arrhythmias, systemic emboli, and endocarditis, which may lead to cardiac failure. Common complications of rheumatic fever include stenosis, carditis, and stroke. Prognosis is generally poor if left untreated.
Natural History
If left untreated, rheumatic fever may cause valvular diseases including stenosis, regurgitation of mitral/aortic valves and myocarditis. This may lead to decreased cardiac output, pulmonary edema and ultimately cardiac failure. If an individual develops rheumatic fever, they will experience the development of increased sensitization to Streptococcus pyogenes autoantigens. Future infection will likely cause an elevated, autoimmunological response and a more severe case of rheumatic fever will develop.
It is estimated that the recurrence rate of rheumatic fever is decreased by about 85% by providing prophylactic penicillin therapy. Recurrence rate of 0.2/patient/year follow-up was noted among those not receiving regular treatment.[1]
Complications
Complications to rheumatic fever include:[1][2][3][4]
- Mitral stenosis
- Aortic stenosis
- Endocarditis
- Myocarditis
- Pericarditis
- Cardiac failure
- Arrhythmias
- Systemic emboli
- Stroke
- Sydenham chorea
- Recurrence of rheumatic fever
Prognosis
For cases intentionally without carditis, the prognosis is excellent, demonstrating no residual heart disease. In cases with preexisting heart disease, the prognosis was poor, leading to mortality.[5]
References
- ↑ 1.0 1.1 Majeed HA, Yousof AM, Khuffash FA, Yusuf AR, Farwana S, Khan N (1986). "The natural history of acute rheumatic fever in Kuwait: a prospective six year follow-up report". J Chronic Dis. 39 (5): 361–9. PMID 3700577.
- ↑ Rheumatic Fever and Rheumatic Heart Disease. World Health Organization (2004). http://www.who.int/cardiovascular_diseases/resources/en/cvd_trs923.pdf Accessed on October 12, 2015.
- ↑ Garg N, Kandpal B, Garg N, Tewari S, Kapoor A, Goel P; et al. (2005). "Characteristics of infective endocarditis in a developing country-clinical profile and outcome in 192 Indian patients, 1992-2001". Int J Cardiol. 98 (2): 253–60. doi:10.1016/j.ijcard.2003.10.043. PMID 15686775.
- ↑ Carapetis JR, Steer AC, Mulholland EK, Weber M (2005). "The global burden of group A streptococcal diseases". Lancet Infect Dis. 5 (11): 685–94. doi:10.1016/S1473-3099(05)70267-X. PMID 16253886.
- ↑ The Natural History of Rheumatic Fever and Rheumatic Heart Disease, Rheumatic Fever Working Party of the Medical Research Council of Great Britain and the American Heart Association (1965). http://circ.ahajournals.org/content/32/3/457 Accessed on October 12, 2015