Acute rheumatic fever

Question 1

What is required for the diagnosis for acute rheumatic fever?

Answer 1

Throat cultures growing GABHS or elevated anti- streptolysin O titers + 2 major criteria OR 1 major criteria & 2 minor criteria

Major (JONES)

• Joint involvement, migratory polyarthritis
• <3 = myocarditis
• Nodules, subcutaneous
• Erythema marginatum
• Sydenham chorea

Minor (CAFE PAL)

• CRP increased
• Arthralgia
• Fever
• Elevated ESR
• Prolonged PR interval
• Anamnesis of Rheumatism
• Leukocytosis

Question 2

What are the investigations required for acute rheumatic fever?

Answer 2

Evidence of preceding GAS infection

• Positive throat culture for GAS
• +ve rapid streptococcal antigen test
• Elevated antistreptococcal Ab titer (ASO or ADB)
• ASO = Antistreptolysin O
• ADB = antideoxyribonuclease B

Blood tests

• CRP, ESR
• FBC

Cardiac evaluation

• ECG
• Echocardiogram

Question 3

What is the management required for acute rheumatic fever?

Answer 3

Symptomatic relief

• Joint pain: Anti inflammatory agents (NSAID) e.g. Aspirin, naproxen
• Heart failure – ACEI, Diuretics
• Pericardial effusions: Pericardiocentesis

Antibiotics: IM penicillin G

Prevention of recurrent attacks

• Monthly injections of penicillin G or oral erythromycin daily
• Treatment recommended until the age of 18 or 21 years