Rheumatic fever

Question 1

What is rheumatic fever?

Answer 1

Rheumatic fever is an autoimmune condition triggered by streptococcus bacteria

Question 2

What is the pathophysiology of rheumatic fever?

Answer 2

Antibodies against the streptococcus bacteria also attack the body, specifically the myocardial tisue

Question 3

What type of hypersensitivity reaction is rheumatic fever?

Answer 3

Type 2

Question 4

What type of streptococcus typically causes rheumatic fever?

Answer 4

Group A beta- haemolytic streptococcus - usually streptococcus pyogenes

Question 5

What streptococcal illness typically preceeds rheumatic fever?

Answer 5

Tonsilitis
Scarlet fever

Question 6

How long after an infection does rheumatic fever occur?

Answer 6

2-4 weeks post infection

Question 7

What is the presentation of rheumatic fever?

Answer 7

Fever
Joint pain
Rash
Shortness of breath
Chorea
Nodules

Question 8

What is the joint involvement of rheumatic fever?

Answer 8

Can cause migratory arthritis - where different joints become inflamed at different times

Question 9

What is the cardiac involvement of rheumatic fever?

Answer 9

All layers of the myocardium are affected, causing:
- Valviultis
- New murmur
- Pericardial rub
- Heart failure

Question 10

What murmur is typically heard in rheumatic fever?

Answer 10

Mitral regurgitation

Question 11

What is the skin involvement of rheumatic fever?

Answer 11

Subcutaneous nodules
Erythema marginatum rash

Question 12

What is investigations are used to diagnose rheumatic fever?

Answer 12

Throat swab
ASO antibody titres
Echo
ECG
CXR

Question 13

What is the Jones criteria for rheumatic fever?

Answer 13

Two major criteria or one major criteria and two minor criteria are needed for diagnosis

Major criteria (JONES):
J - joint arthritis
O - organ inflammation
N - nodules
E - erythema marginatum rash
S - sydenum chorea

Minor criteria (FEAR):
F - Fever
E - ECG changes (prolonged PR interval)
A - arthralgia without arthritis
R - raised inflammatory markers

Question 14

What is the management of rheumatic fever?

Answer 14

Stat dose of IV methylpenicillin
10 days of phenoxymethylpenicillin
Aspirin and steroids for carditis
Prophylactic antibodies for reccurence of rheumatic fever

Question 15

What are the complications of rheumatic fever?

Answer 15

Recurrence of rheumatic fever
Mitral stenosis
Mitral regurgitation
Aortic stenosis and regurgitation