Question

How will you manage a child with rheumatic fever?

Hint:

Secondary prophylaxis is crucial in preventing recurrent episodes of rheumatic fever, which can lead to permanent heart damage.

Answer 1

Step 1: Initial Management of Acute Phase.
The management of a child with rheumatic fever focuses on controlling the acute inflammatory response, preventing progression to rheumatic heart disease, and preventing further streptococcal infections. The main approaches include:
(1) Antibiotic Therapy:
- Penicillin: The first-line treatment for eradicating the streptococcal infection and preventing recurrence. A single dose of benzathine penicillin (IM) or oral penicillin can be given.
- Alternatives: For penicillin-allergic patients, erythromycin or azithromycin can be used to eradicate the group A streptococcal infection.
(2) Anti-inflammatory Treatment:
- Aspirin is used to reduce inflammation and treat the pain associated with polyarthritis. It should be given in high doses initially, followed by tapering as symptoms improve.
(3) Corticosteroids:
- Prednisolone may be used in cases of carditis or severe polyarthritis to reduce inflammation and prevent long-term heart damage.
(4) Symptomatic Treatment:
- Pain management with NSAIDs like ibuprofen to relieve joint pain and swelling associated with polyarthritis.
- Rest is essential during the acute phase to prevent worsening of symptoms and joint damage.
Step 2: Long-Term Management and Prevention of Recurrence.
(1) Secondary Prophylaxis:
- After the initial episode of rheumatic fever, long-term penicillin prophylaxis is recommended to prevent recurrent infections and subsequent episodes of rheumatic fever. This can be done via monthly benzathine penicillin injections or daily oral penicillin.
- Prophylaxis should continue for at least 5 years or until the child reaches 21 years of age, whichever is longer, depending on the severity of heart involvement.
(2) Monitoring for Heart Disease:
- Regular follow-up visits to monitor for signs of rheumatic heart disease. This may include routine echocardiograms to assess valve function, particularly the mitral valve.
- Referral to a cardiologist if there are signs of valve damage or heart failure.
Step 3: Education and Support.
- Provide counseling to the family about the importance of secondary prophylaxis and the prevention of future infections.