Rheumathic fever

Question 1

Define rheumatic fever

Answer 1

Autoimmune disease that follows a group A B-heamylytic streptococci infection
can affect heart joints, skin, muscle

Question 2

Aetiology and Risk factors of rheumatic fever

Answer 2

Believed to be caused by cross reactive AB that react to Group A streptococci and from there find similar antigens in the body
commonly have several recurrence

As autoimmune-Genetic component
Ethnic component (indigenous > non-indigenous westerners)

Question 3

Epidiemology of rheumatic fever

Answer 3

Often children from 5-14. Over 30 is very rare
333000 NEW cases worldwide per year-mainly out of western world -especially in developing counties (subsaharan Africa)
33 mil Rheumathic heart disease

Question 4

Signs and Symptoms of Rheumathic fever

Answer 4

Use the REVISED JONES CRITERIA (2 major, or 1 major +2 minor)

5 Major-Carditis (murmur, pericardial rub, CCF, cardiomegaly, SOB)
Arthritis-migratory polyarthiritis affecting LARGER joints
Subcutaneous bodies-small mobile, painless on joints and spine
Erythrema marginosum-Red raised edges and clear at centre-manly on trunk/arm/thigh
Sydenham’s chorea-unvoluntary semi-purposeful movements (can be preceded by mental changed)

Minor-Fever, raised CRP/ESR, Arthralgia, Prolonged PR, Previous Rheumathic fever

most common-fever and joint pain

ALSO want evidence of group A haemolytic strep infection-
Positive throat culture (usually neg by the time of symptoms)
Strep antigen test +
Rising Strep AB titration
Recent scarlet fever

Question 5

Investigations for Rheumatoid fever

Answer 5

ESR/CRP-raised
WBC-might be elevated
ECG-prolonged PR
CXR-can show CCF
Throat culture
Strep Antigen test
Strep AB test