Indigenous/ ATSI health

Question 1

Acute rheumatic fever begins after an initial infection. This can then lead to rheumatic heart disease.

What two types of infection begin the sequence of events?

Answer 1

1. Bacterial Pharyngitis or Scarlet Fever
2. Superficial skin infection with GAS such as streptococcal pyoderma

Question 2

Acute rheumatic fever occurs after an initial infection.

Describe the duration and what it effects.

Answer 2

Lasts about 10days to 6 weeks

it is a non-suppurative inflammation affecting the cardiac tissue, joints, subcutaneous tissue and nervous system.

Question 3

What is the name of the criteria to diagnose ARF?

Answer 3

Jones criteria.

Question 4

Acute rheumatic fever, needs a high index of suspicion. what combination of features should make you consider it?

(6)

Answer 4

Sore throat in the previous 2–6 weeks

Fever

Lethargy and myalgia

Arthralgia (migrating arthralgia that is asymmetrical in pattern
and affects the large joints)

Indigenous Australians or Pacific Islanders

Living in crowded housing conditions

Question 5

What is the name of this rash found on examination of someone with ARF?

Answer 5

Erythema marginatum

Question 6

What are six features on examination to expect from someone with ARF?

Answer 6

1. Migratory polyarthritis
2. Sydenham Chorea
3. Carditis (potentially heard as pansystolic or early diastolic murmur)
4. Subcutaneous nodules.
5. Erythema marginatum
6. Fever > 38

Question 7

In a rural setting, whilst awaiting for transfer to hospital for a child with acute rheumatic fever, what 6 investigations might you consider starting?

Answer 7

1. Throat swab for GAS
2. Blood cultures if febrile
3. ECG
4. Chest XRAY if clinical evidence of carditis
5. Serology: FBC, ESR, CRP
6. Specific serology: ASO and anti-DNase-B titres

Question 8

Which antibiotic will you administer for acute rheumatic fever?

Answer 8

Benzathine Penicillin, IM, given as a single dose

Dosing depends on age/weight

Question 9

How long do you continue prophylactic antibiotics for after an episode of acute rheumatic fever?

Answer 9

trick question

this used to be 10 years or to age 21, whichever was longer.

However now it depends on specific patient characteristics which can lead to a course as short at 12 months or up to 40 years old.

For mild RHD the old rule applies, but even then they patient needs to meet criteria such as no further episodes of ARF to then consider ceasing prophylaxis.

In any case, a cardiology follow up with echo is necessary.

Question 10

Rheumatic heart disease is primarily when the heart valves (mitral mostly) becomes inflammed and damaged after an episode of ARF. It damage starts to occur relatively soon after any untreated ARF.

What are other complications that arise from RHD?

Answer 10

1. Bacterial Endocarditis
2. Heart failure
3. Complicated pregnancies
4. Ruptured heart valve (emergency)