Rheumatic Fever Flashcards
What is rheumatic fever?
It is defined as a systemic inflammatory disorder, which is related to recent infection with Group A Streptococcus
What Group A Streptococcus organism is associated with rheumatic fever?
Streptococcus Pyogenes
Is rheumatic fever contagious?
No
However, the initial Group A Streptococcus infection is contagious
Describe the pathophysiology of rheumatic fever
The initial Streptococcus infection produces a type II hypersensitivity reaction via molecular mimicry
This is due to similarities in the molecular structure of the streptococcal bacteria cell walls and human heart valve tissue, resulting in the body’s antibodies attacking the host instead of the pathogen
This leads to permanent damage to the heart’s valves, resulting in formation of granulomatous nodules
What term is used to refer to the granulomatous nodules formed in rheumatic fever?
Aschoff bodies
Which five risk factors are associated with rheumatic fever?
Children 5 – 15 Years Old
Female Gender
Family History
Immunocompromised
Group A Streptococcus Infection
What are the six clinical features of rheumatic fever?
Streptococcus Infection Features
Polyarthritis
Carditis Features
Sydenham’s Chorea
Erythema Marginatum
Subcutaneous Nodules
Describe the polyarthritis associated with rheumatic fever
Fleeting arthritis
This describes arthritis that migrates from one joint to another within a period of one to two months
What is carditis?
It is defined as inflammation of the heart - involving one or all of the three layers
What are the three layers of the heart?
Endocardium
Myocardium
Pericardium
How does endocarditis tend to present?
Valvular heart disease
Which heart valve is most commonly affected by rheumatic fever?
Mitral valve
What are the five murmur features of mitral regurgitation?
Holosystolic, High Pitched, Whistling Murmur
Murmur Radiation To Axilla
Quiet, Soft S1
S3 Sound
Widely Split S2
What are the five murmur features of mitral stenosis?
Mid-Diastolic, Low Pitched, Rumbling Murmur
Louder Murmur on Expiration
Loud S1
Tapping Apex Beat
Low Volume Pulse
How does myocarditis tend to present?
Heart failure
It therefore usually presents as dyspnoea, orthopnea and oedema
How does pericarditis tend to present?
Pericardial rub
What is Sydenham’s chorea?
It is defined as involuntary, semi-purposeful movements of the body
In some cases, the chorea is preceded by emotional behaviour which is out of character
When does Sydenham’s chorea tend to present in rheumatic fever?
It is a late clinical feature, which usually presents 2 - 6 months after the initial streptococcal infection
What is erythema marginatum?
It is defined as a pink macular rash predominantly affecting the trunk and limbs
It expands outwards, leaving a pale centre
What are subcutaneous nodules?
They are defined as hard, mobile, painless pea-sized masses
In which two regions are subcutaneous nodules usually located?
Extensor surfaces
Spine
Which three investigations are used to diagnose rheumatic fever?
Blood Tests
Throat Swabs
ECG Scan
What six blood test results are indicative of rheumatic fever?
Increased WCC Levels
Increased ESR Levels
Increased CRP Levels
Increased Troponin Levels
Increased Anti-Streptolysin O (ASO) Levels
Increased Anti-DNAse B Levels
Which two antibodies are associated with rheumatic fever?
Anti-Streptolysin O (ASO)
Anti-DNAse B
How are throat swabs used to diagnose rheumatic fever?
They are used to identify Group A Streptococcus infection
This can either be obtained through a bacterial culture or rapid streptococcal antigen test (RAST)
What are the two features of rheumatic fever on ECG scans?
Tachycardia
Prolonged PR Interval
Which criteria is referred to in order to diagnose rheumatic fever?
Jones criteria
What does Jones criteria state?
It states that individuals must present with…
Streptococcus Infection Features
PLUS
Two Major Criteria
OR
One Major Criterion & Two Minor Criteria
What are the four features of streptococcus infection?
Positive Throat Swab
Positive Rapid Streptococcal Antigen Test (RAST)
Increased Streptococcal Antibody Titre
Recent Scarlet Fever Episode
What are the five major criteria in the ‘Jone’s Criteria’?
Polyarthritis
Carditis Features
Sydenham’s Chorea
Erythema Marginatum
Subcutaneous Nodules
What are the five minor criteria in the ‘Jone’s Criteria’?
Polyarthralgia
Prolonged PR Interval
Rheumatic Fever History
Fever > 39°C
Increased Inflammatory Markers
What is the conservative management option of rheumatic fever?
Bedrest
What is the first line management option of rheumatic fever?
Bedrest
How long do we recommend rheumatic fever patients follow bedrest advice for?
It is usually recommended until the CRP levels have returned to the normal range for at least two weeks
What are the three pharmacological management options of rheumatic fever?
Antibiotics
NSAIDs
Corticosteroids
How are antibiotics used to manage rheumatic fever?
They are used to treat the causative streptococcal infection
What is the first line antibiotic used to manage rheumatic fever?
Penicillin
What dose of penicillin is used to manage rheumatic fever?
A single stat dose of IV benzylpenicillin
This is then followed by oral phenoxymethylpenicillin for a course of ten days
What are the two second line antibiotics used to manage rheumatic fever?
Erythromycin
OR
Azithromycin
When are NSAIDs used to manage rheumatic fever?
They are the first line pharmacological management option used to limit the inflammatory response
Name an NSAID used to manage rheumatic fever
Aspirin
Why do we need to monitor the administration of aspirin in children?
This is due to the associated complications of respiratory alkalosis, metabolic acidosis, tinnitus and Reye’s syndrome
When are corticosteroids used to manage rheumatic fever?
They are the second line pharmacological management option used to limit the inflammatory response
Name a corticosteroid used to manage rheumatic fever
Prednisolone
How do we prophylactically manage rheumatic fever?
Antibiotics
What antibiotic is the first line prophylactic management option of rheumatic fever?
Benzathine penicillin G
How is benzathine penicillin G administered to prophylactically manage rheumatic fever?
It is administered every four weeks as an intramuscular injection
What antibiotic is the second line prophylactic management option of rheumatic fever?
Phenoxymethylpenicillin
How is phenoxymethylpenicillin administered to prophylactically manage rheumatic fever?
It is administered once daily as an oral tablet
What antibiotic is the third line prophylactic management option of rheumatic fever?
Macrolide antibiotics
Name two macrolide antibiotics used to prophylactically manage rheumatic fever
Erythromycin
Azithromycin
How are macrolide antibiotics administered to prophylactically manage rheumatic fever?
They are administered once daily as an oral tablet
What are the seven complications of rheumatic fever?
Rheumatic Heart Disease
Infective Endocarditis
Heart Failure
Pericardial Effusions
Valvular Heart Disease
Atrial Fibrillation
Pulmonary Hypertension
