ARF and RHD cont Flashcards
risk groups for primary prevention of ARF
recommended antibiotic treatment for strep A sore throat/tonsillitis
recommended antibiotic treatment for strep A skin sores
strep A skin sores aare introduced through
a break in the skin eg. insect bite, scabies, headlice, tinea, minor trauma
what do strep A skin sores look like
round or linear,
have pus or thick crust evident
efficacy of cotrimoxazole for skin sores
A three-day course of
twice-daily or a five-day course of once-daily
cotrimoxazole were found to be non-inferior to
BPG for treatment of skin sores.15 Cotrimoxazole
had significantly fewer side effects, was well
tolerated, and provides a pain-free alternative for
treatment of skin sores for children
features of ARF arthritis
usually extremely painful on movement, out of proportion to the clincial signs
very responsive to NSAIDs including aspirin
how to rule out septic arthritis
Patients presenting with monoarthritis should be thoroughly investigated for septic arthritis, as well as rheumatic fever and any other
relevant differential diagnoses. Once initial investigations have been sent, including joint aspirate for microscopy and culture (collected appropriately to avoid clotting of the sample), it may be appropriate to treat presumptively with empirical antibiotics appropriate to cover septic arthritis pathogens until an alternative diagnosis, such as rheumatic fever, is confirmed.
clinical presentation of sydenhaam’s chorea
predominantly affects females, particulalry in adolescence
jerky, uncoordinated movements, especially affecting the hands and feet, tongue and face
dissappear during sleep, may affect one side only
milkmaid’s grip
rhythmic squeezing when the patient grasps the examiners fingers
spooning
flexion of the wrists and extension of the fingers
pronator sign
turning outward of the arms and palms when held above the head
subcutaneous nodules
very rare but highly specific
Nodules are usually 0.5–2 cm in
diameter, round, firm, freely mobile and painless nodules that occur in crops of up to 12 over the elbows, wrists, knees, ankles, Achilles tendon, occiput and posterior spinal processes of the vertebrae. They tend to appear one to two weeks after the onset of other symptoms, last only one to two weeks (rarely more than a month) and are strongly associated with carditis.
clinical appearance of erythema marginatum
It occurs as bright pink macules or papules that blanch under pressure and spread outwards
in a circular or serpiginous pattern. It is rapidly evanescent (that is, waxes and wanes during
the course of a day). The lesions are not itchy or painful, and occur on the trunk and proximal
extremities, but almost never on the face. The rash can be difficult to detect in dark-skinned
people, so close inspection is required.
is antinflammatory medication effective for erythema marginatum
no
carditis
Usually presents clinically as an apical holosystolic (pansystolic) murmur (MR),
and/or an early diastolic murmur at the base of the heart or left sternal edge
(AR)
May only be detected using echocardiography (subclinical carditis)
are NSAIDs effective for arthritis in ARF
yes
strep rapid antigen test
not as accurate as culture, it is recommended that a negative test be followed up with a culture
ddx for polyarthritis with fever
septic arthritis
connective tissue and other autoimmune disease
viral arthropathy
reactive arthropathy
lyme disease
sickle cell anaemia
infective endocarditis
leukaemia or lymphoma
gout and pseudo gout
ddx for carditis
innocent murmur
mitral valve prolapse
congenital heart disease
infective endocarditiis
hypertrophic cardiomyopathy
myocarditis: viral or idiopathic
pericarditis: viral or idiopathic
ddx for sydenham chorea
SLE
drug intoxication
wilson’s disease
tic disorder
cerebral palsy
encephalitis
familial chorea
huntingtons
intracranial humour
lyme disease
how to tell the difference between ARF and post strep reactive arthritis
reactive arthritis will affect joints such as the small joints of the hands not so commonly affected by ARF
reactive arthritis is less responsive to NSAIDs
diagnosis of reactive arthritis should rarely be made it at risk populations
priorities in managing ARF in the acute setting
- culturally safe care
- IM ben pen G
- Influenza vaccine as a strategy to prevent reye’s syndrome for chldren recieving aspirin
- arthritis and fever: paracetamol until diagnosis confrimed, then naproxen, ibuprofen or aspirin once diagnsois is confirmed
carbamazepine or sodium valproate for chorea if severe
bed rest for carditis, anti-failure medication as required
corticosteroids for severe carditis
paediatric anti-failure medication
furosemide
spironolactone
enalapril (choice of ACE inhibitor will depend on the clinical situation
secondary prophylaxis is
the consistant and regular administration of antibiotics to people who has had ARF or rheumatic heart disease to prevent future group A strep infections and the recurrence of ARF
what do you use for secondary prophylaxis
long-acting benzathine benzylpenecillin G
not to be confused with benzyl penecillin
regimen of secondary prophylaxis
benzathine benzylpenecillin G
deep IM injection
every 28 days or every 21 days in some populations
duration of secondary prophylaxis
depends on ARF episode/identified abnormality on echo
how long is secondary prophylaxis for probable ARF with normal echo
minimum 5 years or until age 21, whichever is longer
will also nee follow up echos
