Extra cardiac path (infectious endocarditis, rheumatic fever) Flashcards
Define rheumatic fever
An inflammatory (T2HS) multisystem disorder that arises as a delayed complication of an URTI with beta haemolytic streptococci
What is the aetiology of rheumatic fever
Pharyngeal infection with Lancefield group A beta-haemolytic streptococci triggers rheumatic fever 2-4 weeks later
Pharyngeal infection with Lancefield group A beta-haemolytic streptococci triggers rheumatic fever 2-4weeks later
What criteria is used to diagnose rheumatic fever
Jones
2 major OR 1 major + 2 minor
What is the Jones criteria for rheumatic fever
Major:
Carditis
Arthritis
Sydenham’s chorea
Erythema migracans
Subcutaneous nodules
Fever
Raised ESR
Arthralgia
Prolonged PR
Previous rheumatic fever
What is the management for rheumatic fever
- Admit
- A-E assessment
- Abx
- long-term Abx - benzylpenicillin every 4 weeks until 21yo
What will be seen on histology for rheumatic fever
Aschoft bodies (small giant cell granulomas)
Antischkov myocytes (regenerating myocytes)
What are the types of endocarditis and what will be seen for each
Rheumatic heart disease: WARTY vegetations on valve leaflet
Infective endocarditis: large irregular masses on valve cusps, extends to the chordae tendinae
Non-bacterial thrombotic endocarditis: small, bland vegetation (throbmosis)
Libman sacks: small. sterile, platelet, rich vegetation
What are the causes of infective endocarditis
Dental: strep. viridans
IVDU: staph. aureus (usually causes R-sided IE)
Prosthetic: staph. epidermidis
Farmers: coxiella
Unpasteurised: Brucella
What are the signs and symptoms of infective endocarditis
Hands: Janeway lesions, osler’s nodes, splinter haemorrhages
Eyes: Roth spots
Haematuria (glomerular nephritis)
Splenomegaly
New onset fever
FLAWS symptoms
What criteria is used to diagnose infective endocarditis
Duke’s
2 major
1 major + 3 minor
5 minor
What is the Duke’s criteria for diagnosing infective endocarditis
Major
+ve culture for the typical organisms
2 +ve cultures 24h apart
Vegetations seen on echo
New-onset murmur
Minor
RFs of IE
S/S of IE
+ve blood culture that does not fit major criteria
Fever
What is the management for infective endocarditis
Abx for 6 weeks
Acute: flucloxacillin
Subacute: benzylpenicillin + gentamicin