DOC I HAVE RHEUMATIC FEVER

What is Rheumatic Fever?

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Rheumatic Fever is a febrile disease characterized by arthritis, heart disease, chorea, appearing alone or in combination with subcutaneous nodules and erythema marginatum.

What causes Rheumatic Fever?

The cause is infection with Group A beta-hemolytic Streptococcus.

The streptococcus bacteria usually affects the pharynx or tonsils resulting in an immune response which affects the heart, joints,and skin.

It usually affects children from the age of 5 to 15 years especially in the lower income families.

What are the symptoms of Rheumatic Fever?

1.history of sore throat one to three weeks before onset.

2.fever which is sustained

3.polyarthritis of large joints especially knees, elbows, ankles

4.Migratory arthritis -moves from joint to joint rarely persisting in one joint for more than a few days. The migratory arthritis usually lasts for several weeks.

5.During the arthritis joints are hot, red. swollen and painful but no permanent damage occurs even without treatment.

6.Carditis occurs in 40 per cent and may present as pericardial rub, pericardial effusion, myocarditis with tacycardia with murmur from valvular incompetance(mitral, aortic)
Carditis usually develops early.

7.Skin nodules occur if disease persists.

8.Erythema marginatum also uncommon.

9.Sydenham Chorea ( with emotional instabilty, muscle weakness and quick, uncoordinated jerky movements) is an unusual feature and may persists up to 6 months

10.nosebleeds rarely occurs in Rheumatic Fever

How is the diagnosis of Rheumatic Fever made?

The diagnosis of  Rheumatic Fever involve
1.throat swabs for streptococcus positive in 25 per cent early cases

2.Anti-Streptolysin O titers raised in 80 % of patients

3.ESR rate high

4.C-reactive protein is high in cardiac failure

5.ECG will show prolonged PR intervals and evidence of myocarditis or pericarditis

6.chest xrays show pericardial effusion or cardiomegaly

What are the complications for Rheumatic Fever ?

1.heart valve damage

2.various skin joint and bone problems

3.Sydenham Chorea

What is the treatment for Rheumatic Fever?

Treatment for Rheumatic Fever:

Supportive treatment:
1.bed rest
2.fever medicine
3.treat heart failure with diuretic

Suppresive treatment:
1.Penicillin  intramuscular injection or oral daily or sulphadiazine or erythromycin daily until 18 years old

2.Corticosteroids will suppress severe cardiac lesions.
Duration and dosage depends on severity in a dose of 2mg per kgm per day prednisolone dosage until ESR has gone down then slowly tapered off.

What is the prognosis of Rheumatic Fever?

No permanent joint damage

Cardiac lesions persist and becomes worse each time there is a recurrence of rheumatic fever

Effectiveness of antibiotics against streptococcus determines prognosis.

Outcome is worse with systemic manifestations of disease

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DOC I HAVE BRUCELLOSIS

What is Brucellosis?
Brucellosis is an infectious disease caused by the Brucella bacteria which commonly cause infection in animals.

What is the cause of Brucellosis?

There are 5 forms of Brucella:
1.B.abortis present in cattle
2.B.melitensis -goat
3.B suis -pigs
4.B.canis dogs
5.B.ovis sheep

Infection occurs through contact with tissues of infected animals or by ingesting infected milk products of these animals

They are particularly found in farmers , veterinary surgeons and slaughter house workers.

They are usually found in young males.

The germs localize in the reticuloendothelial cells of liver, spleen, bone marrow, and lymph glands.

What are the symptoms of Brucellosis?

Incubation peroid is 2 to 4 weeks.
Symptoms are:

Mild flu-like attacks with symptoms of:
1.fever

2.headache

3.malaise

4.abdominal pain

5.chills

6.loss of appetite
sometimes episodes of infection can continue for months to years.

Relapses and recurring attacks of fever are usually seen in B.melitensis (or undulant fever -here the fever rises and falls in waves)
Symptoms in these cases are:
1.severe sweating

2.Abdominal pain

3.pains in limbs,back  and joints

4.headache

5.sore throat

6.irritability,insomnia

7.loss of appetite

8.erythematous rash

9.enlarged liver, spleen and lymph glands

10.loss of weight

In more severe cases there may be bleeding

Chronic brucellosis:
1.fever

2.fatigue and weakness

3.tremors

4.rheumatic and muscle pains

5.swollen lymph glands

How is Diagnosis of Brucellosis made?

Diagnosis of Brucellosis is made using:
1.blood, urine and bone marrow cultures

2.raised antibodies titers(more than 1:80) of brucella

3.radioimmunology of specific Brucella immunoglobulins

4.CSF Culture

What are the complications of Brucellosis?

The complications of Brucellosis Fever are:

1.arthritis

2.neurological disturbances and neuritis

3.meningoencephelitis

4.infective endocarditis

5.hepatitis

6.orchitis

What is the treatment of Brucellosis?

Treatment of Brucellosis is by:
1.antibiotic treatment such as tetracycline, septrin, streptomycin

2.continuous antibiotic for months

3.general supportive care:
a.rest
b.analgesics

4.corticosteroids in severe or chronic cases

What is the Prognosis of Brucellosis?

Prognosis:
1.acute uncomplicated disease may remit by itself

2.generally good if treated properly

3.rarely fatal

What are the preventive measures for Brucellosis?

Prevention:

Taking only pasteurized milk and cheeses is the most important way to prevent brucellosis. People who come in contact with animals should wear protective glasses and clothing to avoid  infection.Any skin breaks should be protected from contact with infected animals.

Vaccination is available for cattle but not humans.

Early detection of the disease in animals is important in isolation of animals and preventing infections.

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DOC I HAVE ERYTHEMA NODOSUM

What is Erythema nodosum?

Erythema nodosum is an acute erythematous disease of the skin and subcutaneous tissues characterized by painful nodular erythemous reactions associated with a systemic disease or process.

Erythema Nodosum  is more common in women than it is in men.

What causes Erythema nodosum?

50% per cent of the erythema nodosum has unknown causes .

The remainder 50 per cent has known causes as below:

1.The commonest cause is streptoccocal infections.

Other infections are:
coccideomycosis

histoplasmosis

tuberculosis

Cat scratch disease

Leptospirosis

Infectious Mononucleosis

Psittacosis

Syphilis

Chlamydia

Hepatitis B

Mycoplasma

Mycobacteria

2.Systemic diseases:

sarcoidosis

ulcerative colitis

leukemia

lymphoma

Tularemia

rheumatic fever

3.Drug reaction to antibiotics such as sulphonamides, sometimes tetracycline and

amoxillin and penicillin drugs

oral contraceptives.

progestin

sulphones

What are the symptoms of Erythema nodosum?

Erythema nodosum symptoms is acute in onset with fever and transient joint pain.

1.lesions are bright red, shiny nodules 3-4cm in diameter

2.typically found on shin(anterior tibial surfaces)  but can also occur on the thighs, buttocks, arms

3.lesions can change from pink to blue to brown with appearance like a bruise

4.the lesions are painful throbbing and tender initially

5.legs may be swollen

6.lesions often symmetrical on both legs

7.scattered lesions may occured elsewhere

8.joint swelling

How is the diagnosis of Erythema nodosum made?

The diagnosis of  Erythema nodosum involve
1.typical appearance of skin and mucosa

2.history of bacterial and medical causes.

3.Full blood count showed raied white blood cells and Erythrocytes Sedimentation Rate (ESR)

4.Antistreptococcal titers raised in streptococcal cases

5. mantoux test for tuberculosis

6.Chest X rays showed hilar nodes and evidence of sarcoidosis or tuberculosis

7. Throat swabs for streptococcus

8. Most important is a punch biopsy of a nodule which will confirm the illness under the microscope

What are the complications for Erythema nodosum ?
1.heart valve and kidney disease from streptococcus infection (rheumatic fever)

2. Underlying conditions such as lymphoma , leukemia, sarcoidosis, tuberculous, ulcerative colitis, can be dangerous and fatal

What is the treatment for Erythema nodosum?

Treatment for Erythema nodosum :
1.bed rest and fluids

2.legs with nodules relieved of pressures by elevation with foot rests

3.treat infections with antibiotics

4.Hot or cold compresses to help reduce discomfort

5.analgesis and non steroidal anti-inflammatory drugs for pain and swelling

6.treat underlying cause and remove offending drug or radiation

7.Potassium iodide (SSKI) solution to clear up the nodules.

What is the prognosis of Erythema nodosum?

generally good with proper treatment. It is not dangerous.

However the condition usually go away within about 6 weeks, but may recur.

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