Rheumatic fever with severe carditis!!
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Hello, a boy aged 10 years, presented with a 1-week history of fever, worsening breathlessness and nausea leading to loss of appetite. On clinical examination, he was sweating, tachycardic and a murmur of grade 3/6 was noted. He also stated he had a sore throat 3 months previously, which was dismissed as trivial due to its intermittent nature. His mother highlighted a rash on the upper aspects of both thighs. He had intermittent hip and knee pain for the 12 months, resulting in limping and reduced mobility—emphasised by the fact he was visiting his neighbour much less than usual. He commented on a 3-month history of a change in handwriting at school, and a greater tendency to drop objects, suggestive of a subtle chorea. There was no significant medical history. The birth history includes a 2-week stay in hospital after birth due to ongoing fevers. How to treat this condition?
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@miraj Rheumatic fever is caused by a group A β haemolytic streptococcal infection, and initially presents as a sore throat. Approximately 2–4 weeks later, symptoms manifest as fever, polyarthralgia, polyarthritis, chorea and erythema marginatum. Acute rheumatic carditis occurs when there is a cross-reaction between the bacterial carbohydrate cell wall and the valve tissue (antigenic mimicry), causing chronic damage to valve tissue,6 which is then termed RHD. Risk factors include poverty, overcrowding, lack of access to medical care and young age. There is international consensus on how to reduce the global health burden of RHD; current guidance focuses on secondary antibiotic prophylaxis, primary prevention and primordial prevention by improving living conditions. Themes reinforced in this case report include the need for improved training of healthcare professionals to detect ARF symptoms earlier, informing the population to attend a clinic at an early stage (sore throat, joint pains), access to echocardiography, surgical valve repair rather than replacement and particularly in the case of the latter, enhanced postoperative care.