ACUTE RHEUMATIC FIVER

Reported of rheumatic heart disease in schoolchildren

WHO region year rate ( per 1000 population )

AFRICA
Kenya 1994 2,7
Zambia 1986 12,5
Ethiopia 1999 6,4
Conakry 1992 3,9
DR Congo 1998 14,3
AMERICAS
Cuba 1987 0,2 2,9
Bolivia 1986-1990 7,9
EASTERN MEDITERANEAN
Maroco 1989 3,3 10,5
Cairo 1986-1990 5,1
Sudan 1986-1990 10,2
Saudi arabia 1990 2,8
Tunisia 1990 6,0
SHOUTH-EAST ASIA
Northem India 1992-1993 1,9- 4,8
India 1984-1995 1,0- 5,4
Nepal 1997 1,2
SriLangka 1998 6,0
WESTERN PASIFIC
Cook Islands 1982 18,6
French Polynesia 1985 8,0
New Zeland 1983 6,5( Maoris)
0,9 ( non Maoris)
Samoa 1999 77,8
Australia 1989- 1993 9,8
 Criteria diagnosis rheumatic fever and
rheumatic heart disease,Genewa 2004
Diagnostic category Criteria

Primary episode RF 2 mayor,or 1 mayor and 2 minor plus

Recurrent attack RF without established RHD
Recurrent attack RF with established RHD
evidence of preceding group a streptococcal
infections
2 mayor,or 1 mayor and 2 minor plus
evidence of preceding group a streptococcal
infections
2 minor plus evidence of preceding group a
streptococcal infections

Rheumatic chorea , insidious onset rheumatic Other mayor manifestaions or evidence of

carditis grouf A streptococcal infection not required

Chronic valve lesions of RHD ( patients Do not require any other creteria to be
presenting for the first time with pure mitral diagnosed as having rheumatic heart disease
stenosis or mixed mitral valve disease and/or
aortic valve disease )

Appleton RS at al Rheumatic valvular heart disease. J Lab Clin Med 1985; 105; 114-9
 PENGOBATAN ANTI RADANG PADA DEMAM
REUMATIK
Manifestasi klinis Pengobatan

Atralgia Hanya analgesik ( misal

asetaminopen )
Artritis Salisilat 100 mg/kgBB/ hari selama 2
mgg dan 25 mg/kg BB selama 4 6
mgg

Karditis Prednison 2 mg/kgBB/ hari selama 2

mgg dan diturunkan bertahap 2
mgg, salisilat 75 mg/kgBB/ hari 2
mgg dilanjutkan 6 mgg

Appleton RS at al Rheumatic valvular heart disease. J Lab Clin Med 1985; 105; 114-9
 PENGOBATAN DEMAM REUMATIK
Status Karditis Penatalaksanaan
Tidak ada karditis Tirah baring selama 2 mgg dan
sedikit demi sedikit rawat jalan
selama 2 mgg dgn salisilat
Karditis tdk ada kardiomegali Tirah baring selama 4 mgg dan
sedikit demi sedikit rawat jalan
selama 4 mgg

Karditis dgn kardiomegali Tirah baring selama 6mgg dan

sedikit demi sedikit rawat jalan
selama 6 mgg

Karditis dgn gagal jantung Tirah baring ketat selama masih ada
gagal jantung dan sedikit demi
sedikit rawat jalan selama 3 bulan

Appleton RS at al Rheumatic valvular heart disease. J Lab Clin Med 1985; 105; 114-9
 Jadwal pencegahan demam reumatik
Pengobatan faringitis
( Pencegahan primer )
1. Penisilin benzatin G IM
a. 600.000 900.000 unit
pasien < 30 kg.
b. 1.200.000 unit pasien
> 30 kg
2. Penisilin V oral
250 mg, 3 atau 4 kali
sehari selama 10 hari
3. Eritromisin
40 mg/kg/hari 2 4 kali
dosis sehari ( dosis
aksimum
1 g/hr ) selama 10 hari
Pencegahan infeksi
( Pencegahan sekunder )
1. Penisilin benzatin G IM
a. 600.000 unit pasien < 30 kg. tiap 3 4
minggu
b. 1.200.000 unit pasien > 30 kg setiap
3 4 minggu.
2. Penisilin V oral; 250 mg dua kali sehari.
3. Eritromisin ; 250 mg dua kali sehari.
4. Sulfadiazin ;
a. 0,5 g untuk pasien < 30 kg sekali sehari
b. 1 gr untuk pasien > 30 kg sekali sehari

Appleton RS at al Rheumatic valvular heart disease. J Lab Clin Med 1985; 105; 114-9