72. Acute rheumatic fever

Question 1

What is the cause of acute rheumatic fever

Answer 1

Group a beta HEMOLYTIC strep pyogenes

Question 2

What are the clinical manifestations?

Answer 2

Migratory polyarthritis

Pancarditis

Mitral and aortic regurg- stenosis

Sydenham chorea
Neuropsychiatric symptoms

Subcutaneous nodules

Erythema marginatum-
centrifugally expanding pink or light red rash with a well-defined outer border and central clearing.
Painless and nonpruritic
Location: The trunk and limbs are affected

Acute tonsillitis and pharyngitis

GAS infection of skin - eryispelas , impetigo, cellulitis - tend to be complicated by post strep GN,

Question 3

What is the diagnostics acute rheumatic fever

Answer 3

Jones criteria

Low risk population
Major - 
migratory - primarily the large joints 
Pancreatitis
Sydenham CHorea 
Subcutaneous nodules
Erythema marginatum

Minor criteria
Polyarthralgia 
High fever >38 degrees
Esr crp 
ECG - prolonged PR

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Leukocytosis
Normocytic anemia Of chronic inflammation

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Anti streptolysin o
Anti strep dnase B

Positive throat culture

Positive rapid GAS antigen test

Question 4

Treatment of acute rheumatic fever

Answer 4

Penicillin v

Penicillin v and cephalosporins

Or macrolide

———- ‘

NSAIDS
Naproxen
Aortic

Second line - glucocorticoids , prednisone

——-

Cardiac
Bed rest with gradual ambulation
Treatment of congestive heart failure
Consider corticosteroids
——-
Sydenham Chorea
Rest in calm environment

If difficulty doing activities
Carbamazepine and valporic acid

If persistent
Prednisone 
IVIG
Plasmapheresis
Resperidone