ACUTE RHEUMATIC FEVER

Question 1

What is acute rheumatic fever

Answer 1

An illness caused by an immunological reaction to group A streptococcal infection of the throat

Question 2

Acute rheumatic fever occurs ……………after an untreated or inadequately treated throat infection

Answer 2

1 to 3 weeks

Question 3

Acute rheumatic fever mainly occurs in …………. with a peak age of …………..

Answer 3

Children and adolescents,
5 to 15 years

Question 4

Chronic form of acute rheumatic fever

Answer 4

Rheumatic heart disease

Question 5

How long is secondary prophylaxis given after an episode of acute rheumatic fever

Answer 5

minimum of 10 years or until 21 years whichever is longer

Question 6

Differential diagnosis of acute rheumatic fever

Answer 6

Malaria
Typhoid fever
Febril conditions
Sickle cell disease

Question 7

Jones criteria for diagnosis acute rheumatic fever

Answer 7

Major criteria (SPECC)
Subcutaneous nodules
Polyarthritis
Erythema marginatum
Carditis
Chorea

Minor criteria (PRAFFL)
Previous rheumatic fever
ESR > 30
CRP >3mg/dl
Arthralgia
Leukocytosis
Fever
First degree AV block

Question 8

Chorea

Answer 8

Chorea is a symptom that causes involuntary, irregular or unpredictable muscle movements.

Question 9

Jones criteria for diagnosis of initial acute rheumatic fever

Answer 9

1. Evidence of preceding group A streptococcal infection,
   and
2. 2 major criteria /1 major and 2 minor criteria

Question 10

Jones criteria for diagnosis of recurrent acute rheumatic fever

Answer 10

1. Evidence of preceding group A streptococcal infection,
   and
2. 2 major criteria /1 major and 2 or 3 minor criteria

Question 11

Cause of acute rheumatic fever

Answer 11

Group A streptococcus

Question 12

Symptoms of acute rheumatic fever

Answer 12

Fever
Malaise
Joint pain which moves from one joint to another (knees, ankles, wrists, elbows)
Palpitations
Easy fatiguability
Chest pain
Skin rash
Chorea

Question 13

Signs of acute rheumatic fever

Answer 13

Fever > 38°C (minor criteria)
Arthralgia
Carditis
Skin rash
Subcutaneous nodules over bony prominences

Question 14

Carditis

Answer 14

Rapid heart rate (> 100/minute)
murmur
heart failure
pericardial rub
Echocardiogram evidence of carditis

Question 15

Investigations in acute rheumatic fever

Answer 15

FBC
ESR
CRP
Sickling status
Throat swab for culture
ASO titre
ECG
Echocardiogram

Question 16

Evidence of first degree block on ECG

Answer 16

Prolonged PR interval for age

Question 17

Treatment objectives of acute rheumatic fever

Answer 17

To eradicate streptococcal throat infection
To suppress inflammatory response
To prevent recurrent episodes of rheumatic fever and further heart damage
To treat heart failure if co-existent

Question 18

Treatment for acute rheumatic fever

Answer 18

Benzathine benzylpenicillin or Phenoxymethylpenicillin or Erythromycin
And
Aspirin or Ibuprofen
And
Prednisolone if carditis is present

Question 19

Dose of benzathine penicillin for acute rheumatic fever

Answer 19

Benzathine benzylpenicillin, IM,
≥ 30 kg body weight; 1,200,000 U as a single dose
< 30 kg body weight; 600,000 U as a single dose

Question 20

Dose of prednisolone for acute rheumatic fever

Question 21

Dose of pheoxymethylpenicillin for acute rheumatic fever

Answer 21

Phenoxymethyl penicillin (Penicillin V), oral,
Adults
500 mg 12 hourly for 10 days
Children
6-12years; 250 mg 12 hourly for 10 days
1-5 years; 125 mg 12 hourly for 10 days

Question 22

Dose of erythromycin for acute rheumatic fever

Answer 22

Adults
500 mg 12 hourly for 10 days
Children
8-12 years; 500 mg 12 hourly for 10 days
3-8 years; 250 mg 12 hourly for 10 days
1-2 years; 125 mg 12 hourly for 10 days

Question 23

How long is aspirin given in acute rheumatic fever

Answer 23

until joint symptoms relieved, and gradually
withdraw over 1-2 weeks.

Question 24

Dose of aspirin in rheumatic fever

Answer 24

Adults
300-900 mg 4-6 hourly
Children
1 month-18 years; 25 mg/kg 6 hourly

Question 25

Dose of ibuprofen in acute rheumatic fever

Answer 25

Adults
200-800 mg 6-8 hourly (max. 2400 mg daily)
Children
10-15 mg/kg 6-8 hourly (max. 40 mg per kg daily)

Question 26

Secondary prevention (prophylaxis) of acute rheumatic fever and
rheumatic heart disease

Answer 26

Benzathine benzylpenicillin
or
Phenoxymethylpenicillin
or
Erythromycin

Question 27

Dose of benzathine penicillin for secondary prevention (prophylaxis) of acute rheumatic fever and
rheumatic heart disease

Answer 27

Benzathine benzylpenicillin, IM,
≥ 30 kg body weight; 1,200,000 U
< 30 kg body weight; 450 mg (600,000 U) 4-weekly

Question 28

Dose of phenoxymethylpenicillin for secondary prevention (prophylaxis) of acute rheumatic fever and
rheumatic heart disease

Answer 28

Phenoxymethyl penicillin (Penicillin V), oral,
Adults
500 mg 12 hourly daily
Children
6-12years; 250 mg 12 hourly
1-5 years; 125 mg 12 hourly

Question 29

Dose of erythromycin for secondary prevention (prophylaxis) of acute rheumatic fever and
rheumatic heart disease

Answer 29

Erythromycin, oral
Adults
500 mg 12 hourly
Children
8-12 years; 500 mg 12 hourly
3-8 years; 250 mg 12 hourly
1-2 years; 125 mg 12 hourly