Infective/Misc

Question 1

Jones criteria

Answer 1

The diagnosis of acute rheumatic fever requires:

• 2 major, or
• 1 major and 2 minor manifestations, AND
• evidence of group A streptococcal infection

Required Criteria

Evidence of antecedent Strep infection: ASO / Strep antibodies / Strep group A throat culture / Recent scarlet fever / anti-deoxyribonuclease B / anti-hyaluronidase

Major Diagnostic Criteria

• Carditis
• Polyarthritis
• Chorea
• Erythema marginatum
• Subcutaneous Nodules

Minor Diagnostic Criteria

• Fever
• Arthralgia
• Previous rheumatic fever or rheumatic heart disease
• Elevated acute phase reactant (ESR or CRP)
• Prolonged PR interval

Question 2

Discitis- key features, investigations, treatment

Answer 2

Discitis: inflammation of vertebral disc space (expansion of vertebral osteomyelitis)

• *Age range:** 4-10yrs
• *Features:** more acute onset children >adults, back pain, refusal to walk, irritability, fever, reduced ROM back
• *Ix:** elevated ESR, XR initially normal, then disc space narrowing/irregularity of vertebral end plates
• *Rx:** long term ABx, analgesia

Question 3

Sjogren Syndrome

Answer 3

• 75% F
• Primary Sjogren (sicca) - isolated
• Secondary - assoc with other rheumatic disorders

Pathogenesis: genetic +infectious trigger, lymphocytes and plasma cells infiltrate salivary glands, destroy

Clinical: parotid gland enlargement, parotitis, dry eyes (xeropthalmia), xerostomia (dry mouth), other systemic

Ix: FBE - anaemia, eosinophilia, high ESR, ANA (80%), RF 60%, ANti Ro 75%, Anti La 65%, biopsy - lymphocytic infiltration

Rx: artifical tears/fluids steroid, NSAID, hydroxychlorquinine

Cx: increased risk of MALT lymphoma, neonatal lupus