RHEUMATIC FEVER Flashcards
What is Rheumatic fever?
What are causes of Rheumatic fever
Streptococcal pharyngitis (Strep throat)
Tonsillitis
Scarlet Fever
What pathogen is responsible?
Group A Beta hemolytic streptococcus (GAS)
Who are more susceptible?
Genetics with HLA 1, 2, 3, 4, 7 positive gene
Previous Strep infection
Asians, Africans etc
Clinical manifestations
Carditis
Polyarthritis
Chorea
Erythema marginatum
Subcutaneous nodules
Fever
Arthralgia
Abdominal pain
Hyperhidrosis
What is Chorea
Neural disorder due to inflammation of the basal ganglia characterized by irregular, involuntary, spasmodic movement of limbs and facial muscles
What is erythema marginatum
Pink, nonpruritic, non tender rash involving the trunk and sometimes limbs but never the face
What are subcutaneous nodules
Firm painless pea-sized nodules present on the extensor surface of joints
Usually 0.5-2cm
What is Arthralgia
Joint discomfort and weakness without pain
What is hyperhidrosis
Excessive sweating
Diagnosis of Rheumatic fever
1) JONES CRITERIA
2) BLOOD TEST
- Leukocytosis
- Elevated Acute phase reactants (ESR & C reactive protein)
3) ECHO
- carditis
- valve damage
4) ECG
- 1st degree Heart block
- Prolonged PR interval
5) ANTIBODY TITER TEST
- Elevated antistreptolysin O (ASO) antibody
What is the Jones criteria divide into
1) MAJOR CRITERIA
2) MINOR CRITERIA
What are the Jones Major Criteria
Carditis
Polyarthritis
Chorea
Erythema Marginatum
Subcutaneous nodules
Previous GAS infection
What are the Jones minor criteria
Fever
Arthralgia
Previous Rheumatic fever
Elevated ESR & CRP
Prolonged PR interval on ECG
Previous GAS infection
Differential diagnosis
Infective Endocarditis
Juvenile Idiopathic Arthritis
Kawasaki’s disease
Lyme disease. Sarcoidosis
Rheumatoid arthritis
Reactive arthritis
SLE
Treatment
1) General Treatment
2) Anti infection treatment
3) Antiinflammatory Treatment
4) Supportive therapy
5) Prevention measures
General Treatment;
Bed rest
1-2wks Arthritis alone
2-3wks Carditis without enlarged heart
4-6wks carditis with enlarged heart
2-4months carditis + enlarged heart+ heart Failure
Antinfective treatment
Treat GAS infection;
1) Penicillin
- IV 10 to 14dys
2) Erythromycin
- if allergic to penicillin
Antiinflammatory Treatment
1) Salicylates
- Aspirin 30-60mg/kg/day, reduce dose after 2wks
•Arthritis alone 6-8wks
•Mild Carditis 12wks
2) Corticosteroids
- Prednisone
•2mg/kg/day 2-4wks then reduce dose
• 8-12wks or until negative CRP
•Given if CHF or severe carditis
Supportive care:
1) CHF
Digitalis
Digoxin 5-10ug/kg/d
Bed rest
2) chorea
Phenobarbital
Other sedatives
Prevention:
1) Primary Prevention
- Treat GAS infection
2) Secondary Prevention
- Prevent more GAS infection
What type of inflammation classification is Rheumatic fever
Type II hypersensitivity
Pathophysiolgy of Rheumatic fever
Through MOLECULAR MIMICRY
antibody produced by activated plasma cells act on both the pathogen and hostcs heart and joints
