Rheumatic fever

Question 1

Describe epidemiology of Acute rheumatic fever?

Answer 1

• Children
• High income countries

Question 2

Pathogenesis of Acute rheumatic fever?

Answer 2

• Immune-mediated delayed response to infection
  
  • Group A streptococci
• Antigens that cross-react with cardiac myosine and sarcolemmal membrane proteins

Question 3

Histology of Acute rheumatic fever?

Answer 3

• Fibrinoid degeneration in collagen of connective tissues
• Aschoff nodules in the heart
  
  • Multinucleated giant cells surrounded by macrophages and T lymphocytes

Question 4

Clinical features of Acute rheumatic fever?

Answer 4

• Fever, anorexia, joint pain
• Following streptoccal pharyngitis
• Rashes, subcutaneous nodules, carditis

Question 5

Diagnosis of Acute rheumatic fever?

Answer 5

Jones criteria

Question 6

Describe Sydenham’s chorea?

Answer 6

• St. Vitus dance
• Emotional lability
• -> Purposeless, involuntary movements of the hands, feet or face

Question 7

Investigations in Acute rheumatic fever?

Answer 7

• Evidence of systemic illness
  
  • Leucocytosis, ESR and CRP elevated
• Evidence of preceding streptococcal infection
  
  • Throat swab culture
• Evidence of carditis
  
  • CXR: Cardiomegaly, pulmonary congestion
  • ECG: AV block, T wave inversion, reduced QRS voltages
  • Echo: Cardiac dilatation and valve abnormalities

Question 8

Describe the management of Acute rheumatic fever?

Answer 8

• Bed rest
• Treatment of heart failuyre
• Antibiotics
  
  • Benzylpenicillin single dose
  • Erythromycin if pen allergic
• Aspirin
• Glucocorticoids