Other Flashcards

1
Q

What is Rheumatic Fever?

A

Acute autoimmune inflammatory multi-systemic illness mainly affecting children 5 - 15 yo*

symptomatic or asymptomatic infection with GABHS Group A ß-Hemolytic Streptococcus* (aka Strep pyogenes) stimulates antibody production to host tissues & damages organs directly. The infection usually precedes the onset of rheumatic fever by 2 - 6 weeks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Complications of Rheumatic Fever

A

rheumatic valvular disease: mitral* (75 - 80%), aortic (30%)’ tricuspid and pulmonic (5%)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Diagnosis of Rheumatic Fever

A

Clinical Diagnosis using the 2015 Jones Criteria

2 Major OR 1 major + 2 minor

1. Joint (migratory polyarthritis)

2. Oh my heart (active carditis)

3. Nodules (subcutaneous)

4. Erythema Marginatum

5. Sydenham’s chorea

Minor Criteria:

Fever (> 101.3)

Arthralgia

Laboratory – î acute phase reactants (îESR, CRP, leukocytes)

ECG: prolonged PR interval

PLUS: supporting evidence of a recent group A streptococcal infection (positive throat culture or rapid antigen detection test &/or elevated/increasing streptococcal antibody titers ASO)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Major Criteria of Rheumatic Fever

A

1. POLYARTHRITIS: (75%) 2 or more joints affected (simultaneous more diagnostic) or migratory (lower ⇒ upper joints). Medium/large joints MC (knees, hips, wrists, elbows, shoulders). Heat, redness, swelling, severe joint tenderness must be present. Joint pain (Arthralgia) without other symptoms doesn’t classifiy as major. Usually lasts 3 - 4 wks

2. ACTIVE CARDITIS: (40 - 60%) can affect valves (especially mitral & aortic), myocardium (myocarditis), &/or pericardium (pericarditis). Carditis confers great morbidity & mortality

3. SYDENHAM’S CHOREA: (< 10%) “Saint Vitus Dance” may occur 1 - 8 months after initial infections. Manifestations include sudden involuntary, jerky, non-rhythmic, purposeless movements, especially involving the head/arms. Usually resolves sponaneously, MC in females

4. ERYTHEMA MARGINATUM: often accompanies carditis. Macular, erythematous, non-pruritic annular rash with rounded, sharply demarcated borders (may have central clearing). MC seen primarily on the trunk & extremities (not the face). Crops last hours-days before disappearing.

5. SUBCUTANEOUS NODULES: rare. seen over joints (extensor surfaces), scalp & spinal column

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Management of Rheumatic Fever

A
  1. Anti-inflammatory: Aspirin (2 - 6 wks with taper); + corticosteroids in severe cases & carditis
  2. Penicillin G antibiotic of choice (or Erythromycin if PCN-allergic) both in acute phase & after acute episode. Prevention is the most important therapeutic course. Therefore all patients (even if presenting with acute rheumatic fever) should be treated with antibiotics.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q
A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly