RHEUMATIC FEVER

Question 1

What is Rheumatic fever?

Question 2

What are causes of Rheumatic fever

Answer 2

Streptococcal pharyngitis (Strep throat)
Tonsillitis
Scarlet Fever

Question 3

What pathogen is responsible?

Answer 3

Group A Beta hemolytic streptococcus (GAS)

Question 4

Who are more susceptible?

Answer 4

Genetics with HLA 1, 2, 3, 4, 7 positive gene
Previous Strep infection
Asians, Africans etc

Question 5

Clinical manifestations

Answer 5

Carditis
Polyarthritis
Chorea
Erythema marginatum
Subcutaneous nodules
Fever
Arthralgia
Abdominal pain
Hyperhidrosis

Question 6

What is Chorea

Answer 6

Neural disorder due to inflammation of the basal ganglia characterized by irregular, involuntary, spasmodic movement of limbs and facial muscles

Question 7

What is erythema marginatum

Answer 7

Pink, nonpruritic, non tender rash involving the trunk and sometimes limbs but never the face

Question 8

What are subcutaneous nodules

Answer 8

Firm painless pea-sized nodules present on the extensor surface of joints
Usually 0.5-2cm

Question 9

What is Arthralgia

Answer 9

Joint discomfort and weakness without pain

Question 10

What is hyperhidrosis

Answer 10

Excessive sweating

Question 11

Diagnosis of Rheumatic fever

Answer 11

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

Question 12

What is the Jones criteria divide into

Answer 12

1) MAJOR CRITERIA
2) MINOR CRITERIA

Question 13

What are the Jones Major Criteria

Answer 13

Carditis
Polyarthritis
Chorea
Erythema Marginatum
Subcutaneous nodules
Previous GAS infection

Question 14

What are the Jones minor criteria

Answer 14

Fever
Arthralgia
Previous Rheumatic fever
Elevated ESR & CRP
Prolonged PR interval on ECG
Previous GAS infection

Question 15

Differential diagnosis

Answer 15

Infective Endocarditis
Juvenile Idiopathic Arthritis
Kawasaki’s disease
Lyme disease. Sarcoidosis
Rheumatoid arthritis
Reactive arthritis
SLE

Question 16

Treatment

Answer 16

1) General Treatment
2) Anti infection treatment
3) Antiinflammatory Treatment
4) Supportive therapy
5) Prevention measures

Question 17

General Treatment;

Answer 17

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

Question 18

Antinfective treatment

Answer 18

Treat GAS infection;
1) Penicillin
- IV 10 to 14dys
2) Erythromycin
- if allergic to penicillin

Question 19

Antiinflammatory Treatment

Answer 19

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

Question 20

Supportive care:

Answer 20

1) CHF
Digitalis
Digoxin 5-10ug/kg/d
Bed rest
2) chorea
Phenobarbital
Other sedatives

Question 21

Prevention:

Answer 21

1) Primary Prevention
- Treat GAS infection
2) Secondary Prevention
- Prevent more GAS infection

Question 22

What type of inflammation classification is Rheumatic fever

Answer 22

Type II hypersensitivity

Question 23

Pathophysiolgy of Rheumatic fever

Answer 23

Through MOLECULAR MIMICRY
antibody produced by activated plasma cells act on both the pathogen and hostcs heart and joints