RHEUMATIC FEVER

Question 1

Definition and Cause (5)

Answer 1

• Infection with Group A streptococcus Pyogens (GAS) —> autoimmune reaction
• Develops 2-3 weeks after onset of sore throat
• While rheumatic heart disease is the chronic valvular abnormalities secondary to acute rheumatic fever mostly MS
• Incident fallen dramatically in industrialized countries
• Aschoff’s bodies seen in pathology of heart

Question 2

Diagnostic Criteria- Major Criteria (5)

Answer 2

(JONES)
- Joints: Polyarthritis of large joints; fleeting
- Cardiac: murmurs (MR or AR), CHF, Pericarditis (pericardial rub)
- Subcutaneous Nodules over tendons/joints/bony prominences
- Erythema marginatum (transient pink coalescent rings on trunk)
- Sydenham’s chorea (involvement of CNS)

Question 3

Minor Criteria (5)

Answer 3

• Fever
• ESR or CRP elevated or leukocytosis (acute phase reactants)
• Prior history of rheumatic fever or rheumatic heart disease
• Prolonged PR interval on ECG
• Arthalgia

Question 4

What does diagnosis require? (3)

Answer 4

2 major criteria OR
1 major and 2 minor + throat culture growing GAS OR
Elevated anti-streptolysin O titres

Question 5

Treatment (6)

Answer 5

• Complete bed rest (especially important in those with carditis)
• High dose aspirin (to control the arthritis, fever, and other acute symptoms)
• Penicillin (to eradicate residual streptococcal infection)
• Treatment monitored with CRP
• Predinoslone if cardiac involvement
• Treat valvular pathology

Question 6

Rheumatic fever with carditis and residual heart disease (persistence valvular disease). What’s the duration after last attack?

Answer 6

10 years or until age 40, whichever is longer

Question 7

Rheumatic fever with carditis but no residual heart disease (no valvular disease). What’s the duration after last attack?

Answer 7

10 years or until age 21, whichever is longer

Question 8

Rheumatic fever without carditis. What’s the duration after last attack?

Answer 8

5 years or until age 21, whichever is longer

Question 9

Prevention

Answer 9

Penicillin (erythromycin if allergic) in case of streptococcal pharyngitis