Acute rheumatic fever is a kind of human autoimmune disease caused by streptococcal infection. It is usually formed after pharyngeal inflammation caused by group A β hemolytic streptococcal infection. It mainly invades human heart, joints, central nervous system and subcutaneous tissue, causing inflammation.The main clinical manifestations are fever, migratory arthritis, carditis, erythema multiforme, chorea and other symptoms.
TCM disease name
Acute rheumatic fever
Foreign name
acute rheumatic fever、ARF
Visiting department
Rheumatology and Immunology Department
Common diseases
Heart, joints, central nervous system and subcutaneous tissue
Common causes
Abnormal immune response that may be secondary to group A beta hemolytic streptococcal infection
Acute rheumatic fever is caused by group A βStreptococcus hemolyticusThe cause may be the abnormal immune reaction secondary to streptococcal infection.
clinical manifestation
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Fever:The fever of acute onset patients is between 38 ℃ and 40 ℃, without certain heat type, sweating, fatigue, anorexia, and weight loss.
Migratory polyarthritis:The knee, ankle, shoulder, wrist, hip, elbow and other large joints are most easily affected, which are characterized by local redness, swelling, heat, pain and movement disorders, often related to climate change and humidity, but do not produce permanent joint deformity, which is common in adults.
Cardiac inflammation:It is common in children, including myocarditis, pericarditis and endocarditis.
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myocarditis: Palpitation, shortness of breath, rapid heart rate and out of proportion to body temperature, mild or obvious enlargement of the heart, attenuation of the first heart sound in the apical region, and blowing like systolic murmur can also be heard in the apical region.Tachycardia and premature contraction may occur, and congestive heart failure may occur in severe cases.
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pericarditis: Pain in precordial area, enlarged heart dullness, and pericardial friction sound can be heard.
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endocarditisMitral valve and aortic valve are easy to be involved, and murmurs caused by valve insufficiency and stenosis of different degrees may appear.
Skin damage:Erythema that is not fixed often appears on the inside of the trunk and limbs.
Chorea：The limbs are involuntary, aimless and uncoordinated, the facial expression is strange, the language is unclear, the excitement is intensified, and disappears after falling asleep.
inspect
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laboratory examination
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The anti streptolysin "O" test showed that the titer of serum anti streptolysin O began to rise one week after streptococcal infection.After 2 months, it gradually decreased.If the titer gradually increases, it is of great value in the diagnosis of rheumatic fever and rheumatic activity.
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The white blood cell count, neutrophil, erythrocyte sedimentation rate and C-reactive protein were increased.ECG examination
ECG:Electrocardiogram showed various arrhythmias and prolonged P-R interval.
X-ray examination:It shows mild to moderate enlargement of the heart, mainly left ventricle.
Ultrasonic examination:It has important diagnostic value for finding heart valve disease.
diagnosis
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Acute rheumatic fever is mainly diagnosed according to clinical symptoms and signs and laboratory tests.
treatment
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Early penicillin treatment was given to the patients diagnosed with streptococcal infection.Rheumatic fever patients are prone to relapse after streptococcal infection, and each relapse aggravates heart damage, so preventing streptococcal infection is very important to prevent recurrence of rheumatic fever.
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General treatment:It should be emphasized that bed rest in acute phase can reduce the burden on the heart.With the principle of easy digestion and rich nutrition, people with heart failure should eat a low salt diet.
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medication:Arthritis patients can take 0.1~0.2 g of betamethasone orally, three times a day;Indomethacin 25-50 mg, 3 times a day.
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Prevention of streptococcal infection:If often suffering from tonsillitis, it can be removed surgically.
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other:In case of acute heart failure, the patient shall take the end sitting position, lower limbs drooping or supine position, reduce the amount of blood returning to the heart, reduce the heart load, and send the patient to the hospital for emergency treatment.
prevention
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Penicillin can be used to treat primary infection to prevent the recurrence of rheumatic fever.
