Rheumatic Fever Flashcards

1
Q

what is the definition of rheumatic fever

A

inflammatory multisystem disorder
autoimmune
following a beta-haemolytic streptococci infection

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2
Q

what group of strep is a beta-haemolytic streptococci infection

A

group A strep

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3
Q

what is the GAS (a beta-haemolytic strepococci infection) which causes rheumatic fever

A

s. pyogenes

initially a throat infection

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4
Q

what is the aetiology of rheumatic fever

A

initially a streptococcal pharyngeal infection
genetic susceptibility may be present
molecular mimicry plays an important role in initiation of tissue injury (antibodies against GAS antigens cross react with host antigens)

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5
Q

what is the epidemiology of rheumatic fever

A

peak incidence 5-15yrs
mean incidence is 20 per 100,000PA
common in far east, middle east, eastern europe, south america
less common in west

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6
Q

what history is associated with rheumatic fever

A
presentation 2-5wks post GAS infection
general
-fever
-malaise
-anorexia
cardiac
-SOB
-chest pain
-palpitations
joints
-painful
-swollen
-impaired function
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7
Q

what criteria is used for examination in suspected rheumatic fever

A

duckett jones criteria

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8
Q

what constitutes diagnosis using the duckett jones criteria

A

2 or more major criteria

1 major and 2 or more minor criteria

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9
Q

what are the duckett jones major criteria for rheumatic fever

A

CASES

Carditis
-new murmur(Carey Coombs murmur) a mid diastolic murmur due to mitral valve inflammation
-pericarditis
-pericardial effusion/rub
-cardiomegaly
-HF
Arthritis
-migrating polyarthritis
-swelling, redness, tenderness of large joints
Sydenham's Chorea
-rapid, involuntary, irregular movements
-slurred speech
-more common in females
Erythema marginatum(20% of cases)
-short periods of red rashes with raised edges
-present on trunk and proximal limbs
-form crescent/ring-shaped patches
Subcutaneous nodules
-small, firm, painless nodules
- on joints and tendons
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10
Q

what are the duckett jones minor criteria for rheumatic fever

A

PEACH FEVER

Prolonged PR and QT intervals (if carditis not present)
ESR raised
Arthralgia (if arthritis or present)
Acute phase reactants raised (WCC, ESR, CRP)
CRP raised
History of previous RF/rheumatic heart disease/recent streptococcal infection

FEVER

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11
Q

what would indicate recent streptococcal infection

A

positive throat cultures

raised antistreptolysin O titre

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12
Q

what investigations would be performed in suspected rheumatic fever

A
1 bloods
-FBC(raised WCC)
-raised ESR/CRP
-raised antistreptolysin O titre
2 throat swab
-culture for GAS infection
-streptococcal antigen test
3 ECG
-'saddle shaped' ST elevation and PR segment depression(feature of pericarditis)
-arrhythmias
4 echo
-pericardial effusion
-myocardial thickening/dysfunction
-valvular dysfunction
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13
Q

what is the management for rheumatic fever

A

Conservative
-strict bed rest for 4wks
Medical
-anti-inflammatories (high dose aspirin, corticosteroids if severe)
-antibiotics (oral penicillin V for 10 days for strep infection, long term antibiotics to prevent recurrence such as benzathine penicillin G IM every 4wks)
-treat carditis by treating HF (diuretics)
-treat chorea with diazepam/haloperidol
Surgical
-only if medical therapy fails

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14
Q

what complications are associated with rheumatic fever

A

recurrence
-more common with cardiac damage
-precipitated by streptococcal infection
chronic rheumatic valvular disease
-more common when acute RF presents with carditis
-scarring, deformation, dysfunction of mitral/aortic valves after 10-20yrs

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15
Q

what is the prognosis associated with rheumatic fever

A

acute RF may last 3months if untreated

females more likely to develop mitral stenosis

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