ArtsAutosBooksBusinessEducationEntertainmentFamilyFashionFoodGamesGenderHealthHolidaysHomeHubPagesPersonal FinancePetsPoliticsReligionSportsTechnologyTravel

Acute Rheumatic Fever: Physical Presentations And Health Significance In Multi- Organ Affection

Updated on March 22, 2014

Manifestations Of Acute Rheumatic Fever

Source

A General Overview

Acute rheumatic fever affects multiple organs, depending on its progression and stage. The commonest organs affected are: the heart, joints, body coordination and the skin. The Health implications, pathology, causes, epidemiology and its progression as an infective disease has been discussed in the previous hub. Just go down this hub and click on the previous hub in the slide show to go through it.

In some cases, prodromal symptoms include epitasix (bleeding from the nose), erythema nodosum and vague discomfort. Rheumatic fever starts abruptly as a remittent or intermittent pyrexia with characteristic sweating. In many cases, other manifestations may not develop for considerable periods, so that the diagnosis may be unsuspected in them. In 20 to 50% of cases, the fever is accompanied by polyarthritis and carditis. Sometimes these are mild and go unrecognized especially in children.

Knee Arthritis In A Rheumatic Fever Patient

Source

Arthritis

Acute arthritis affecting the major joints is the characteristic involvement. The joints show signs of acute inflammation and exquisite pain which make the subject immobile. Knees and ankles are most often affected followed by hips, elbows, wrists and shoulders. Small joints are affected only rarely. The arthritis is migratory and fleeting and leaves behind no residual changes. Sometimes the manifestation may be subacute with arthralgia, pain and tenderness over the neighbouring tendons and muscles. This is generally described as growing pains in children. Jaccoud’s arthritis is a rare form of rheumatic arthritis where joint deformities are more common and this resembles rheumatoid arthritis, but cardiac involvement is rare.

Radiograph Of Carditis In Rheumatic Fever

Source

Carditis

There may be clinical features of endocarditis, myocarditis, and pericarditis in varying combinations. Tachycardia out of proportion of fever, arrhythmias, gallop rhythm, and congestive cardiac failure should suggest the presence of myocarditis. Mild cardiomegaly may be evident in the skiagrams. Arrhythmias include frequent ectopics, paroxysmal tachycardias, atrial fibrillation and heart blocks.

Presence of endocarditis is evidence by the appearance of murmurs or change in the quality of the already existing murmurs. Mitral, aortic, tricuspid and pulmonary valves are affected in the order of frequency. Actue valvulitis may lead to mitral and aortic regurgugation. Sometimes, a low pitched mid-diastolic murmur may be heard in the mitral area due to acute mitral valvulitis (Carey- Coomb’s murmur). It is transient and disappears as the valvulitis aubsides. As the valvulitis heals, fibrosis occurs and this distorts the valve apparatus resulting in stenotic and regurgitant lesions. Pericarditis is clinically manifested as chest pain, presence of pericardial rub, or a small pericardial effusion.

Sydenham’s Chorea In A Scarlet Fever Patient

Source

Rheumatic Chores (Sydenham’s Chorea, St. Vitus Dance, Minor Chorea)

Since chorea sets in much later than the other manifestations of rheumatic fever, in many cases, it may be the only abnormality encountered. Chorea is more common in females. It is characterized by involuntary movements which are quasi-purposive, no- repititve, rapid and jerky; and these involve mainly the distal joints. Upper limbs are mostly involved, but the lower limbs, face and tongue may also be involved to a lesser extent. These movements may be mistaken for tantrums or fidgety behaviour. Emotional disturbances are frequent and these aggravate the chorea. The limbs are hypnotic and when the hands are held outstretched, they assume characteristic postures (choreic hand). The movements disappear during sleep. Chorea is self-limiting and it completely disappears withint weeks or months, without leaving any neurological sequel. Subjects developing chorea have a higher incidence of cardiac involvement.

Skin Manifestations In Scarlet Fever

Source

Skin Manifestations

Subcutaneous nodules: They are firm, non tender, pea-sized nodules seen over the extensor aspects of the forearm, elbows, ankles, scalp and scapulae. These last for 1 to 2 weeks and disappear. The risk of carditis is high in those who develop rheumatic nodules.

Erythema marginatum: These are erythematous non- pruritic annular lesions with serpiginous borders, usually seen over the anterior aspects of the chest and abdomen and over the thighs. They spread peripherally like ripple with central clearing. The lesions blanch with pressure. In coloured races, this lesion is difficult to identify, unless carefully examined in good light.

In conclusion, other rheumatic manifestations include, pleurisy and pneumonitis which are not generally evident clinically, these are made out more often by investigations.

© 2014 Funom Theophilus Makama

Comments

    0 of 8192 characters used
    Post Comment

    • married2medicine profile imageAUTHOR

      Funom Theophilus Makama 

      4 years ago from Europe

      Thank you so much Eiddwen

    • Eiddwen profile image

      Eiddwen 

      4 years ago from Wales

      Very interesting, well informed and will benefit so many. Great hub.

      Eddy.

    working

    This website uses cookies

    As a user in the EEA, your approval is needed on a few things. To provide a better website experience, hubpages.com uses cookies (and other similar technologies) and may collect, process, and share personal data. Please choose which areas of our service you consent to our doing so.

    For more information on managing or withdrawing consents and how we handle data, visit our Privacy Policy at: https://hubpages.com/privacy-policy#gdpr

    Show Details
    Necessary
    HubPages Device IDThis is used to identify particular browsers or devices when the access the service, and is used for security reasons.
    LoginThis is necessary to sign in to the HubPages Service.
    Google RecaptchaThis is used to prevent bots and spam. (Privacy Policy)
    AkismetThis is used to detect comment spam. (Privacy Policy)
    HubPages Google AnalyticsThis is used to provide data on traffic to our website, all personally identifyable data is anonymized. (Privacy Policy)
    HubPages Traffic PixelThis is used to collect data on traffic to articles and other pages on our site. Unless you are signed in to a HubPages account, all personally identifiable information is anonymized.
    Amazon Web ServicesThis is a cloud services platform that we used to host our service. (Privacy Policy)
    CloudflareThis is a cloud CDN service that we use to efficiently deliver files required for our service to operate such as javascript, cascading style sheets, images, and videos. (Privacy Policy)
    Google Hosted LibrariesJavascript software libraries such as jQuery are loaded at endpoints on the googleapis.com or gstatic.com domains, for performance and efficiency reasons. (Privacy Policy)
    Features
    Google Custom SearchThis is feature allows you to search the site. (Privacy Policy)
    Google MapsSome articles have Google Maps embedded in them. (Privacy Policy)
    Google ChartsThis is used to display charts and graphs on articles and the author center. (Privacy Policy)
    Google AdSense Host APIThis service allows you to sign up for or associate a Google AdSense account with HubPages, so that you can earn money from ads on your articles. No data is shared unless you engage with this feature. (Privacy Policy)
    Google YouTubeSome articles have YouTube videos embedded in them. (Privacy Policy)
    VimeoSome articles have Vimeo videos embedded in them. (Privacy Policy)
    PaypalThis is used for a registered author who enrolls in the HubPages Earnings program and requests to be paid via PayPal. No data is shared with Paypal unless you engage with this feature. (Privacy Policy)
    Facebook LoginYou can use this to streamline signing up for, or signing in to your Hubpages account. No data is shared with Facebook unless you engage with this feature. (Privacy Policy)
    MavenThis supports the Maven widget and search functionality. (Privacy Policy)
    Marketing
    Google AdSenseThis is an ad network. (Privacy Policy)
    Google DoubleClickGoogle provides ad serving technology and runs an ad network. (Privacy Policy)
    Index ExchangeThis is an ad network. (Privacy Policy)
    SovrnThis is an ad network. (Privacy Policy)
    Facebook AdsThis is an ad network. (Privacy Policy)
    Amazon Unified Ad MarketplaceThis is an ad network. (Privacy Policy)
    AppNexusThis is an ad network. (Privacy Policy)
    OpenxThis is an ad network. (Privacy Policy)
    Rubicon ProjectThis is an ad network. (Privacy Policy)
    TripleLiftThis is an ad network. (Privacy Policy)
    Say MediaWe partner with Say Media to deliver ad campaigns on our sites. (Privacy Policy)
    Remarketing PixelsWe may use remarketing pixels from advertising networks such as Google AdWords, Bing Ads, and Facebook in order to advertise the HubPages Service to people that have visited our sites.
    Conversion Tracking PixelsWe may use conversion tracking pixels from advertising networks such as Google AdWords, Bing Ads, and Facebook in order to identify when an advertisement has successfully resulted in the desired action, such as signing up for the HubPages Service or publishing an article on the HubPages Service.
    Statistics
    Author Google AnalyticsThis is used to provide traffic data and reports to the authors of articles on the HubPages Service. (Privacy Policy)
    ComscoreComScore is a media measurement and analytics company providing marketing data and analytics to enterprises, media and advertising agencies, and publishers. Non-consent will result in ComScore only processing obfuscated personal data. (Privacy Policy)
    Amazon Tracking PixelSome articles display amazon products as part of the Amazon Affiliate program, this pixel provides traffic statistics for those products (Privacy Policy)