Rheumatic Fever

Question 1

What is the characteristic pathological lesion of Rheumatic fever?

Answer 1

ASCHOFF BODIES formed of lymphocyes, plasma cells, macrophage

Question 2

What is the most common organism to cause rheumatic fever?

Answer 2

Group A beta hemolytic streptococci

Question 3

How to Diagnose Acute Rheumatic fever (1st Attack)?

Answer 3

Two Major criteria, or
One Major + 2 Minor

Plus
Evidence of recent streptococcus infection

Question 4

What is the evidence of recent streptococcus infection in Rheumatic fever?

Answer 4

. Increased or rising anti-streptolysin O titer, or other anti-streptococcal antibodies (anti DNAaseB)
. A rise in titer is better than a single titer result
. A positive throat culture for Group A beta Hemolytic streptococcus

Question 5

Treatment of streptococcus infection before rheumatic fever?

Answer 5

Oral Penicillin V for 10 days

If pemnicillin allergy: erythromycin or clarithromycin for 10 days

Question 6

Treatment of Acute Rheumatic Fever

Answer 6

*Eradication of strept with oral Penicillin V for 10 days

*for arthritis: Aspirin 100mg/kg/day for 2w
*for carditis:
>if mild to moderate: continue aspirin for 4-8 w
>if severe: prednisone 2mg/kg/day for 2-6 w + aspirin 75 mg/kg/day (half dose of arthritis)

*for chorea: phenobarbitone/ haloperidol/steroids

Question 7

Secondary Prophylaxis of RH

Answer 7

• IM penicillin.
An injection of 0.6-1.2 million units of benzathine penicillin G
 intramuscularly every 2 weeks in areas where rheumatic fever is
endemic, in patients with residual carditis, and in high-risk patients
• Oral penicillin: 50mg BID
• Oral Sulfadiazine.
• Oral Erythromycin: 250mg BID

Question 8

Duration of secondary prophylaxis of RF

Answer 8

• No cardiac affection : to 18Years or a least 5years following
  1rst attack
• Documented carditis: to 25years and often longer till 40years
• Chronic carditis and artificial valve: for life