Diagnosis and Management of Rheumatic Fever and Measles

JONES CRITERIA

It is used to standardize the diagnosis of rheumatic fever, requiring either two major criteria or one major criterion and two minor criteria, plus evidence of a previous group A-hemolytic streptococcal infection.

MAJOR CRITERIA

1) Carditis 2) Migratory polyarthritis 3) Sydenham's chorea 4) Subcutaneous nodules 5) Erythema marginatum

MINOR CRITERIA

1) Fever 2) Arthralgia 3) Elevated acute phase reactants 4) Prolonged PR interval

TREATMENT

Effective management includes eradicating the streptococcal infection, relieving symptoms, and preventing recurrence to reduce the chance of permanent cardiac damage.

ANTIBIOTICS

Prompt treatment of GAS pharyngitis with antibiotics, including Penicillin or Erythromycin for patients hypersensitive to penicillin.

SALICYLATE

Aspirin is used to relieve fever and minimize joint swelling and pain.

CORTICOSTEROID

Used if the patient has Carditis or if pain and inflammation fail to relieve.

BED REST

Strict bed rest for about 5 weeks for patients with active carditis.

HEART FAILURE TREATMENT

Includes bed rest, sodium restriction, ACE inhibitors, digoxin, and diuretics.

CORRECTIVE SURGERY

Required for severe mitral or aortic valvular dysfunction causing persistent heart failure.

COMMISSUROTOMY

Surgery done to separate the adherent or thickened leaflets of the mitral valve.

VALVULOPLASTY

Surgery done by inflating a balloon within the valve.

VALVE REPLACEMENT

Surgery done using a prosthetic valve.

SECONDARY PREVENTION

Monthly I.M. injections of penicillin G benzathine or daily oral penicillin V or Sulfadiazine beginning after the acute phase subsides.

DURATION OF PREVENTIVE TREATMENT

Usually continues for at least 5 years or until age 21, whichever is longer.

ACTIVITY INTOLERANCE

Related to pain and decreased cardiac output.

HIGH RISK FOR INFECTION

Related to increased susceptibility to group A beta-hemolytic streptococci.

RUBEOLA

A highly contagious, acute viral disease characterized by Koplik's spots and a spreading maculopapular rash.

ETIOLOGY OF RUBEOLA

Caused by a paramyxovirus and is spread by airborne droplets or direct contact with nasopharyngeal secretions.

COMMUNICABILITY OF RUBEOLA

Communicable from 4 days before the rash appears until the rash disappears.

INCUBATION PERIOD OF RUBEOLA

Incubation period is from 8-14 days.

PRODROMAL PHASE

Begins about 11 days after exposure to the virus and lasts from 4-5 days.

KOPLIK'S SPOTS

Hallmark of the disease, appearing as tiny, bluish gray specks surrounded by a red halo on the oral mucosa.

RASH CHARACTERISTICS

Starts as faint macules behind the ears, neck, and cheeks, becoming papular and erythematous, spreading over the entire body.

CLIMAX OF RUBEOLA

Occurs 2-3 days after the rash appears, marked by a temperature of 39.4 C to 40.6 C, severe cough, rhinorrhea, and puffy red eyes.

COMPLICATIONS OF RUBEOLA

Includes secondary bacterial infections, viral pneumonia, encephalitis, and delayed subacute sclerosing encephalitis.

DIAGNOSTIC TESTS FOR RUBEOLA

Diagnosis is based on symptom pattern, positive culture of secretions, and a fourfold increase in specific antibodies.

THERAPEUTIC MANAGEMENTS FOR RUBEOLA

Includes bed rest, isolation during prodrome, skin care, antipyretics, Vitamin A supplementation, and prophylactic anti-infective drugs.

PREVENTION OF RUBEOLA

Vaccination with a combination of measles, mumps, rubella (MMR), with the first dose given at 12-18 months and the second dose at 2-13 years.

CONTRAINDICATIONS TO MEASLES VACCINES

Includes immunosuppression, allergy to neomycin or kanamycin, and severe reaction to a previous dose.

TUBERCULOSIS

A recurrent, chronic infectious and extrapulmonary disease characterized by formation of granulomas with caseation, fibrosis, and cavitation.

Mycobacterium Tuberculosis

Primary bacterium causing tuberculosis infection.

Airborne Transmission

Spread through inhalation of infected droplets.

Cavitary Lesions

Holes in lung tissue, highly infectious.

Hematogenous Spread

Infection dissemination through blood circulation.

Primary Stage

Initial asymptomatic infection lasting about 3 weeks.

Latent Stage

Dormant infection with potential for reactivation.

Recrudescent Stage

Active disease with necrotic lesions and spread.

Pulmonary Symptoms

Weight loss, cough, fever, and fatigue.

Cardiovascular Symptoms

Pericarditis, chest pain, and edema.

Gastrointestinal Symptoms

Abdominal pain, vomiting, and anorexia.

Neurological Symptoms

Meningitis, headache, and consciousness decline.

Musculoskeletal Symptoms

Joint pain, swelling, and motion limitation.

Genitourinary Symptoms

Dysuria, hematuria, and infertility.

Lymphatic Symptoms

Enlarged lymph nodes indicating infection.

Complications of TB

Pneumothorax, brain abscess, and organ failure.

Mantoux Test

Skin test indicating past TB infection.

Sputum Culture

Identifies TB bacteria within 2-3 weeks.

Chest X-ray

Shows lung lesions but not definitive.

Anti-tubercular Drugs

Combination therapy for treating TB infection.

Direct Observed Therapy (DOT)

Supervised treatment to ensure compliance.

Chemoprophylaxis

Preventive treatment for at-risk individuals.

Nutritional Management

High-calorie diet to support recovery.

Isolation Precautions

Prevent spread by isolating infectious patients.

Adverse Effects Monitoring

Watch for drug-related complications in patients.

Regular Follow-ups

Essential for monitoring TB treatment effectiveness.

Immunosuppression Risk

Increases likelihood of TB infection and complications.

Bovine TB

TB strain transmitted from cattle to humans.

Sputum Smear

Acid-fast test for TB bacilli presence.

Biopsy/Culture

Tissue sample confirming TB infection.