Rheumatic fever

Question 1

what organism causes rheumatic fever ?

Answer 1

Group A β-haemolytic strep. (pyogenes)

Question 2

what is the pathophysiology of rheumatic fever?

Answer 2

Ab cross-reactivity following S. pyogenes infection → T2 hypersensitivity reaction (molecular mimicry).
􏰀 Abs. vs. M protein in cell wall.
􏰀 Cross react ̄c myosin, muscle glycogen and SM cells.
􏰀

Question 3

what cells are found in rheumatic fever

Answer 3

Path: Aschoff bodies and Anitschkow myocytes.

Question 4

what criteria is used for rheumatic fever?

Answer 4

Revised Jones Criteria

Question 5

what is the criteria in Revised Jones Criteria?

Answer 5

Evidence of GAS infection plus: 􏰁
2 major criteria, or
􏰁 1 major + 2 minor

Question 6

give some examples of evidence of GAS infection?

Answer 6

+ve throat culture
􏰀 Rapid strep Ag test
􏰀 ↑ ASOT or DNase B titre
􏰀 Recent scarlet fever

Question 7

state the 5 major criteria for rheumatic fever?

Answer 7

Pancarditis
􏰀 Arthritis
􏰀 Subcutaneous nodules
􏰀 Erythema marginatum
􏰀 Sydenham’s chorea

Question 8

what does erythema marginatum look like and where does it occur on the body?

Answer 8

Red, raised edges ̄c central clearing.
􏰀
Trunk, thighs and arms.

Question 9

state some signs of Sydenham’s Chorea ?

Answer 9

Grimacing, clumsy, hypotonia (stops in sleep)

Question 10

what investigations should be done for rheumatic fever?

Answer 10

Bloods
􏰀 Strep Ag test or ASOT
􏰀 FBC, ESR/CRP 
ECG
Echo

Question 11

what is the treatment for Sydenham’s Chorea ?

Answer 11

haloperidol

diazepam

Question 12

what is the treatment for rheumatic fever?

Answer 12

Benpen 0.6-1.2mg IM for 10 days

Question 13

what valve is most commonly affected by rheumatic fever?

Answer 13

Mitral (70%)
􏰁 Aortic (40%)
􏰁 Tricuspid (10%) 􏰁
Pulmonary (2%)