Rheumatic fever

Question 1

At what age is rheumatic fever most likely to occur?

Answer 1

5-15 years

Question 2

What triggers rheumatic fever?

Answer 2

Pharyngeal infection with lancefield group A beta-haemolytic streptococci

Strep. throat

Question 3

What is the main serious cardiac consequence of rheumatic fever?

Answer 3

Permanent damage to heart valves. This is because an antibody to the carbohydrate cell wall of the stretococcus cross-reacts with valve tissue- antigen mimicry

Question 4

What criteria are used for diagnosis of rheumatic fever?

Answer 4

Revised Jones criteria

There must be evidence of recent strep infeciton plus 2 major criteria or 1 major + 2 minor

Question 5

What are the major Jones criteria?

Answer 5

Polyarthritis- usually affected larger joints
Carditis- tachycardia, murmurs, pericardial rub, cardiomegaly, conduction defects
Subcutaneous nodules- small mobile painless nodules on extensor surfaces of joints and spine
Erythema marginatum- rash with red, raised edges and clear centre, occurs mainly on the trunk, thighs and arms
Sydenham’s chorea (St. Vitus’ dance): A characteristic series of rapid movements without purpose of the face and arms. This can occur very late in the disease for at least three months from onset of infection.

Question 6

What is considered evidence of recent group A beta-haemolytic strep infection?

Answer 6

Positive throat culture (although this is usually negative by the time symptoms of rheumatic fever appear)

Rapid streptococcal antigen test positive

Elevated or rising streptococcal antibody titre

Recent scarlet fever

Question 7

What are the minor Jones criteria?

Answer 7

fever
raised ESR or CRP
Arthralgia (not if arthritis is a major criteria)
Prolonged PR interval (not if arthritis is a major criteria)
Previous rheumatic fever

Question 8

How is rheumatic fever managed?

Answer 8

1. bed rest
2. Benzylpenicillin IV stat, then penicillin 4 times daily PO for 10 days
3. Analgesia for carditis/athritis- aspirin or alternatively use NSAIDS and add prenisolone if moderate to severe carditis is present
4. Immobilize joints in severe arthritis
5. Haloperidol or diazepam for chorea

Question 9

What might precipitate recurrence of an acute rheumatic fever attack in a patient with chronic rheumatic heart disease?

Answer 9

Pregnancy
OCP
Further streoptococcal infection

Question 10

What is used for secondary prophylaxis in patients with chronic rheumatic heart disease?

Answer 10

Penicillin once daily

OR sulfadiazine or erythromycin twice daily if penicillin allergic