Rheumatic fever is a non-suppurative, acute inflammation, a complication of an infection with group A streptococci pharyngeal (SGA) which has a combination of arthritis, carditis, subcutaneous nodules, erythema migrans and chorea result. Diagnosis is based on the modified Jones criteria, medical history, clinical examination and laboratory tests. The treatment includes acetyl salicylic acid and other NSAIDs and corticosteroids during a very severe carditis and antibiotics to eradicate the rest Residualinfektion with streptococci and prevent reinfection.

The first episode of acute rheumatic fever (ARF) may occur at any age but is most common 5-15 years, which is the main age for a streptococcal pharyngitis. ARF is uncommon before 3 years and after 21 years. However, a previous symptomatic pharyngitis is detected only about two thirds of patients with ARF.

Rheumatic fever is a non-suppurative, acute inflammation, a complication of an infection with group A streptococci pharyngeal (SGA) which has a combination of arthritis, carditis, subcutaneous nodules, erythema migrans and chorea result. Diagnosis is based on the modified Jones criteria, medical history, clinical examination and laboratory tests. The treatment includes acetyl salicylic acid and other NSAIDs and corticosteroids during a very severe carditis and antibiotics to eradicate the rest Residualinfektion with streptococci and prevent reinfection. The first episode of acute rheumatic fever (ARF) may occur at any age but is most common 5-15 years, which is the main age for a streptococcal pharyngitis. ARF is uncommon before 3 years and after 21 years. However, a previous symptomatic pharyngitis is detected only about two thirds of patients with ARF. Worldwide, the incidence is 19 / 100,000 (the range is between 5 and 51 / 100,000) with the lowest frequency (<10 / 100,000) in North America and Western Europe and the highest frequency (> 10 / 100,000) in Eastern Europe, the Middle East, Asia, Africa, Australia and New Zealand. The percentage of patients with untreated pharyngitis of group A streptococci, a developing ARF, varies between <1.0 to 3%. Higher rates of infection can occur with streptococci Proteinserogruppe M and accompanied by a more vigorous immune response. (Probably as a result of so far uncharacterized genetic tendencies). In patients with a previous episode with ARF the relapse with ARF can be 50% for an untreated streptococcal pharyngitis. This underlines the importance of a long-term prophylaxis against streptococci. The incidence has declined in most developed countries, but remains high in the less developed parts of the world, especially Share with natives or indigenous population and Alaska Native, Canadian Inuit, Native American, Australian Aboriginal and Maori New Zealanders, where the incidence 50 amounts to 250 / 100,000. But the continuing outbreaks of ARF in the United States indicate that there is still virulent rheumatogenic streptococcal strains in the US. The prevalence of chronic rheumatic heart disease is unknown, because the criteria are not standardized and an autopsy is not performed routinely, but it is estimated that worldwide there are ? 15 million patients with rheumatic heart disease, which leads to approximately 200.00 deaths annually. Tips and risks patients who had rheumatic fever, have a 50% chance of relapse if they have another episode of streptococcal pharyngitis in Group A, which is untreated. Pathophysiology pharyngitis by group A streptococci (SGA) is an etiologic precursor of acute rheumatic fever, but the host and environmental factors are important. SGA-M proteins share epitopes (antigenic determinants recognized by the antibodies) to proteins that are found in synovial fluid, cardiac muscle and heart valve. It is believed that a molecular component by GAS antigens of rheumatogenic strains for arthritis, carditis and flaps injury contributes. The genetic risk factors of the host are a D8 / 17-B-cell antigen and a certain class II Histokompabilitätsantigene. Malnutrition, overcrowding and low socioeconomic status predispose to a streptococcal infection, and in consequence, also for episodes of rheumatic fever. Remarkably, although GAS infections of both the throat and other areas of the body (skin and soft tissues, bones or joints, lungs and blood) can lead to post-streptococcal glomerulonephritis, non-pharyngitis GAS infections do not lead to ARF. The reason for this significant difference in complications that are caused by infection by the same organism is not well understood. The joints, the heart, the skin and the central nervous system are affected most often. The pathology varies. The joints involvement of the joints is manifested in a nonspecific synovial inflammation, which sometimes contains small parts at a biopsy, which resemble Aschoff body (granulomatous collection of leukocytes, monocytes, and interstitial collagen). Unlike the heart findings, the abnormalities of the joints are not chronic, however, leaving no scars or residual value changes ( "ARF licks the joints but bites the heart"). Heart A cardiac involvement manifests typically as carditis, the heart from the inside affected outwardly d. H. first valves and the endocardium, myocardium and then finally pericardium. This development sometimes takes years to decades later, a chronic rheumatic heart disease by itself, recognizable primarily by Klappenstenosen, but sometimes also by regurgitation, arrhythmias and ventricular dysfunction. In acute rheumatic fever is Aschoff body often develop in the myocardium and in other parts of the heart. A non-specific fibrous pericarditis, sometimes with effusion, is found only in patients with an endocardial inflammation and usually passes without permanent damage. Characteristic and potentially dangerous valve disorders can occur. Acute interstitial valvulitis can cause Klappenödem. In chronic rheumatic heart disease, valve thickening, retraction and Klappenverklebung or other destruction of the leaflets or flaps pockets can occur. As a result, it comes to stenosis and insufficiency. Similarly, the chordae may tendiniae shorten thicken or stick to and aggravate an insufficiency of the damaged valve or cause a failure in an otherwise not affected flap. Dilation of the valve annulus can also lead to failure. Rheumatic valvular heart disease involves most frequently the mitral and aortic valves. The tricuspid and pulmonary valve, if at all, only rarely affected by itself. In acute rheumatic fever, the most common cardiac manifestations mitral insufficiency pericarditis aortic regurgitation, are sometimes at chronic rheumatic heart disease, the most common cardiac manifestations mitral aortic regurgitation (often with a degree of stenosis) Maybe tricuspid regurgitation (often with mitral stenosis) Subcutaneous skin nodules are not of them a juvenile idiopathic arthritis (JIA) to be distinguished, but biopsy shows similarities with Aschoff-nodules. Erythema marginatum histologically different from other skin lesions with similar macroscopic appearance, z. For example, skin redness in the systemic (JIA), Henoch-Schonlein Purpura, erythema chronicum migrans and erythema multiforme. Perivascular neutrophil and mononuclear infiltration of the skin come vor.Zentralnervensystem The Sydenham's chorea, chorea of ??a mold, which occurs in the ARF is manifested in the CNS as hyperperfusion and increased metabolism of the basal ganglia. Increased anti-euro-dimensional antibody levels were also found. Symptoms and complaints The first symptoms of rheumatic fever show typically 2-3 weeks after streptococcal infection. Typical of the symptoms is a combination of manifestations of the joints, the heart, the skin and the CNS (1). Joints A migratory polyarthritis is the most common manifestation of acute rheumatic fever. It comes about in front at 35 to 66% of children and is often accompanied by fever. Migratory means that the arthritis appears in one or a few joints, back, but then appear in other, so apparently moved from one joint to another. Occasionally monarthritis occurs in a high-risk indigenous population (z. B. in Australia, India, Fiji), but very rare in the United States. Joints are extremely painful and tender; these symptoms are out of all proportion to the moderate heat and swelling that is present in the study (this is in contrast to arthritis in Lyme disease in this study findings more serious than the symptoms seem to be). The ankles, knees, elbows and wrists are normally involved. The shoulders, hips and narrow joints of the hands and feet can be affected as well, but never alone. When the vertebral joints are involved, another disease should be considered. a tenosynovitis can develop the muscle attachment points. Arthralgieartige symptoms may occur in the periarticular regions due to nonspecific myalgia and Tendodynien. The joint pain and fever cease within 2 weeks and rarely last longer than> 1 Monat.Herz Carditis may alone or in combination with pericardial, heart murmurs, enlarged heart or heart failure. In 50 to 70% of cases carditis may occur in the first episode of acute rheumatic fever. Patients can high fever, chest pain, or have it both ways; Tachycardia is common, especially during sleep. Cardiac injury occurs in 50% of cases, much later on (z. B. persistent valve dysfunction). Although carditis of ARF is considered a pancarditis (including endocardium, myocardium and pericardium) that valvulitis is the most stable feature of the ARF, and if it is not present, the diagnosis should be reconsidered. The diagnosis of valvulitis done classically by auscultation of noise, but subclinical cases (d. H. Valvular dysfunction that does not manifest itself through sounds, but is detected by echocardiography and Doppler studies) may occur in up to 18% of cases of ARF. Heart murmurs are common and are, although they occur early in general, often not heard at the first examination; In these cases, repeated clinical examinations are recommended as well as echocardiography to rule out carditis. Mitral regurgitation is characterized by an apical pansystolisches snorting noise that radiates into the armpit. The gentle diastolic bubbles at the left sternal border of aortic and mitral stenosis presystolic sound of a sometimes difficult to detect. The sounds may persist indefinitely. When it comes in the following 2-3 weeks no deterioration, new manifestations of carditis are rare. ARF typically does not lead to a smoldering to himself chronic carditis. The scars after an acute injury flaps can contract and change and lead to secondary hemodynamic difficulties in the myocardium without the persistence of acute inflammation. Pericarditis can be manifested by chest pain and a pericardial rub. Heart failure by a combination of carditis and valve dysfunction dyspnea without rales, nausea and vomiting, a pain in the right upper quadrant and epigastric and a choppy, non-productive cough may cause. Marked lethargy and fatigue can early signs of heart failure sein.Haut The cutaneous and subcutaneous appearances are rare and almost never alone occur. They usually develop in patients who already have a carditis, arthritis or chorea. The subcutaneous nodules, mostly along the Extensorseite the great Gelnke (z. B. knees, elbows, wrists) can be found, are usually present with arthritis and carditis. Less than 2% of children with acute rheumatic fever have such nodules. They are painless, passager and respond to the treatment of joint or heart inflammation. Erythema marginatum is an emerging flat or slightly rising, non-scarring and painless redness. Less than 6% of children have this rash. The rash usually appears on the trunk and proximal extremities, but not the face. sometimes it takes less <1 day. The appearance after a severe streptococcal infection is often delayed and may appear with or after the other manifestations of rheumatoid inflammation. Erythema marginatum © Springer Science + Business Media var model = {thumbnailUrl: '/-/media/manual/professional/images/370_rheumatic_fever_erythema_marginatum_slide-2_springer_high_de.jpg?la=de&thn=0&mw=350' imageUrl: '/ - / media / manual /professional/images/370_rheumatic_fever_erythema_marginatum_slide-2_springer_high_de.jpg?la=de&thn=0 ', title:' erythema marginatum 'description:' u003Ca id = "v37897957 " class = ""anchor "" u003e u003c / a u003e u003cdiv class = ""para "" u003e u003cp u003eDiese figure shows the typical serpiginous rash erythema marginatums in a child with acute rheumatic fever u003c / p u003e u003c / div u003e 'credits.: '© Springer Science + Business Media'

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