DIAGNOSTICS
Laboratory examination:
1. complete blood count – in active phase of the disease leukocytosis with left shift,
acceleration of ESR, anemia are revealed.
2. biochemical blood analysis – nonspecific inflammation signs: increasing of
diphenylamine reaction and C-reactive protein, dysproteinemia with increasing of α2-
and γ- globulin; increased level of sialic acids (SA)
3. Immunological examination – increasing of antistreptococcal antibodies titer (ASG,
ASL-O, ASK), increasing of immunoglobulins A, M,G, circulating immune complexes,
anti-cardiac antibodies. In children of school age positive reaction for ASL-O is titer
more then 320 units, norm is - 160 units.
Diagnostic criteria of acute rheumatic fever:
I. Major criteria:
1. carditis
2. polyarthritis
3. juvenile chorea
4. erythema annulare
5. subcutaneous rheumatic nodules
II. Minor criteria:
1. Clinical:
acute rheumatic fever or rheumatic heart disease in anamnesis
arthralgia
fever, fatigability, stomachache
2. Laboratory – increasing of ESR, SA, C-reactive protein, leukocytosis
3. electrocardiographic - prolongation of P-Q interval (or P-R)
For diagnostics of acute rheumatic fever verification of previous streptococcic
infections is obligatory: increased antistreptococcal antibodies titer, isolation of
streptococci group A from pharynx, previous scarlet fever.
For diagnostics of acute rheumatic fever presence of two great or one great and two
small criterions and verification of previous streptococcic infections, caused by
streptococci of group A is necessary.
THE TREATMENT.
Treatment of child with acute rheumatic fever is step-by-step, adequate, long, continuous
and complex. Stages of treatment: hospital (1-st stage), local cardio-rheumatological
sanitarium (2-nd stage) and regular medical check-up in polyclinic (3-d stage).
First stage – at acute rheumatic fever hospitalization is necessary.
1. Bed rest is necessary at suspicion on rheumatic carditis. Its duration is 2-3 weeks then
one passes to partial load regimen. At absence of cardiac insufficiency Mb regimen
with physical activity limitation, which observe to ESR normalization. Gradual
regimen expansion is realized on checking of clinic-laboratory results and tests with
graduated physical exercise.
2. Diet – on background of hormonal treatment it is recommended to increase the
amount of the products, containing potassium (the potatoes, cabbage, dried apricots,
raisins, prune and others) in diet. At cardiac insufficiency and edemas it is necessary
to limit liquids and table salt.
3. antibacterial therapy:
- an antibiotics of penicillin group during 10-14 days in average therapeutic doses, then
parenteral bicillin-5 in dose 750000 ED in/m 1 time at 30 days for preschoolers, 1 500
000 ED in/m for schoolchildren.
- at penicillin intolerance macrolides are prescribed: erythromycin in dose 30-50
mg/kg/day, in 4 doses; or spiramycin - 3 mln IU in 2 doses during 10 days; azithromyc -
10мг/kg in 1 dose, 3 days; roxithromycin - 5мг/kg in 2 doses during 10 days;
clarithromycin - 15 mg/kg/ in 2 doses, 10 days.
- at penicillin and macrolides intolerance lincosamides are prescribed: lincomycin - 30
mg/kg in 3 doses, 10 days.
4. antiinflammatory therapy by nonsteroid(al) and steroid antiinflammatory preparations:
ibuprofen
Prednizolon in dose 0,4-0,5 mg/kg per day (not more 1 mg/kg) is prescribed at
clinically apparent activity of the process. Complete dose of preparation is given
for 2 weeks. Then dose of nonsteroid antiinflammatory preparations is reduced on
50% and maintained during 1,5-2 month. Steroid hormones is taken off gradually.
5. at continuously recurrent and low-intensity rheumatic carditis aminoquinolines are
prescribed – chloroquine, plaquenil: 5-10 mg/kg per day during 3-6 month. On
background of these preparations it is possible to reduce the dose of steroids and
nonsteroidal antiinflammatory preparations or to canceal it.
6. Treatment of cardiac insufficiency – cardiac glycoside are prescribed, dose is selected
individually on ECG checking.
Prevention.
I. Primary prevention:
1. treatment of acute streptococcic infections by antibiotics in age-specific doses, minimum
for 7 days.
II. Secondary prevention:
1. if patient had acute rheumatic fever without cardiac valves lesion and without centre of the
chronic infections – year-round injection of prolonged action penicillins – bicillin-5 for 3
years is prescribed.
2. if patient had primary rheumatic carditis with cardiac valves lesion, as well as at prolonged
and continuously recurrent course of process, recurring rheumatic carditis, at presence of
chronic infection foci prevention by bicillin-5 is prescribed for 5 years.
3. at appearance of acute or exacerbation of chronic diseases 10-days course of the penicillin
and ibuprofen on background of bicillin-5 are prescribed.
4. treatment of infections foci
5. health promotion program: sanatorium treatment, rational diet, graduated exercise and
others.