Rheumatic fever

Question 1

Outline the Jones criteria for acute rheumatic fever?

Answer 1

Suggest need to have 2 major criteria, or one major and 2 minor criteria.
Diagnosis depends on prevalence of the disease. If high prevalence of disease, then there will be a higher PPV.

Major criteria
Chorea - purposless movements, milking action of hands. Can last up to 6 months.
Migrating arthritis - inflammation in large joints in quick succession.
Erythema marginatum - trunk and arms, face sparing, non itchy, annular.
Carditis
Subcutaneous nodules - lie over tendons, non itchy.

Minor criteria 
Arthralgia 
Fever
Raises CRP
Prolonged PR interval.

Question 2

List 3 diagnostic investigations you can order to diagnosis streptococcal pharyngitis?

Answer 2

Throat culture - note 75% of patients may have negative swab by the time rheumatic fever appears.

Anti streptolysin O titres - tires in healthy school age children maybe around 200-300, in asymtomatic carriers, tires tend to be low, and those who have been infected tend to peak at 4-5 weeks post strep throat or second to third week of acute rheumatic fever.

Or rapid strep antigen test

anti DNase Ab

Question 3

What implications does ARF cause on the heart?

Answer 3

Carditis, myocarditis, endocarditis, pericarditis
tends to cause mitral valve stenosis and aortic valve stenosis
50% of persons with ARF will go on to get rheumatic heart disease 10-20 years time.

Question 4

List the 3 mainstays of treatment for acute rheumatic fever?

Answer 4

Antibiotic therapy
Heart failure management
Anti-inflammatory treatment

Question 5

List 3 indications for antibiotic treatment in group A strep infection?

Answer 5

Prevent non suppurative complications including post strep glomerulanephritis or acute rheumatic fever

1. Age 2-25 years in communities with high incidence of acute rheumatic fever
2. Existing RHD
3. Scarlet fever

Question 6

What is scarlet fever?

Answer 6

Strep throat, fever and rash

Question 7

Describe the scarlet fever rash?

Answer 7

Sandpaper like
Pastia lines - petichiae like that tends to follow lines
blanching red rash that tends to start on head and spread
Strawberry tongue

Question 8

What antibiotics would you use in suspected strep infection?

Answer 8

Penicillin 500mg BD orally if compliance is ok, BD dose is adequate.

If non compliant use IMI injection
Benzathine penicillin 900mg in persons > 20kg, once only.

If hypersensitive to penicillin use cephalsoporin 1g BD

Azithromycin 500mg daily for 5 days.

Question 9

What is a quinsy?

Answer 9

Peritonsilar abscess
Trismus - restricted opening of mouth
UNilateral tonsillar enlargement
Sore throat