Rheumatic Fever

Question 1

Define Rheumatic Fever:

Answer 1

Inflammatory Infection that starts at the throat by Group A/B Haemolytic Streptococci, and after 2-4 weeks –> triggers Rheumatic Fever.
Streptococci Pyogenes Infection
Systemic Infection: CT, Heart, Joints, Brain, Skin.
Peak Incidence: 5-15 years.
Can cause long term damage to heart & valves -> RHD.

Question 2

Rheumatic Fever: Symptoms: 
F
A
A
C
E
SC
SN

Answer 2

Rheumatic Fever: Symptoms: 
Fever
Arthralgia - joint pain
Arthritis - joint inflammation
Carditis - heart inflammation
Erythema Marginatum - Red Rash
Sydenham's Chorea (involuntary, semi-purposeful movements)
Subcutaneous Nodules

Question 3

Rheumatic Fever: Disease: Revised Jones Criteria:
There must be evidence of recent Streptococcus infection plus 2 major criteria, or 1 major and 2 minor criteria.
Major Criteria: SC, SN, A, EM, C
Minor Criteria: F, A, ESR/CRP, PR, RF

Answer 3

Rheumatic Fever: Disease: Revised Jones Criteria:
Major Criteria:
Sydenham’s Chorea (involuntary, semi-purposeful movements), Subcutaneous Nodules, Arthritis, Erythema Marginatum - Red Rash, Carditis.
Minor Criteria:
Fever, Arthralgia, Raised Erythrocyte sedimentation rate, or C-Reactive Protein.

Question 4

Evidence of Group A/B Haemolytic Streptococcal Infection: 
PTC
RSAnT
RSAbT
RSF

Answer 4

Evidence of Group A/B Haemolytic Streptococcal Infection:
Postive Throat Culture
Rapid Streptococcal Antigen Test = +
Raised/Rising Streptococcal Antibody Titre
Recent Scarlet Fever

Question 5

Rheumatic Fever: Primary Treatment: 
BR
BZP
A
IJ
H/D
(Plus Secondary Prophylaxis - on next card)

Answer 5

Rheumatic Fever Treatment:
Bed Rest: until CRP is normal - for 2 weeks and possibly 3 months.
Benzylpenicillin: 0.6-1.2g IV, followed by Penicillin 250-500mg 4x/day = 10 days
Analgesia - carditis/arthiritis - Aspirin 100mg/kg over 2 days, then 70mg/day for weeks.
Immobilise Joints - in severe arthiritis
Haloperidol/Diazepam - for Sydenham’s Chorea/

Question 6

Rheumatic Fever: Secondary Prophylaxis: 
P
Duration without carditis:
Duration with carditis:
Duration with carditis & persistent valvular disease:

Answer 6

Rheumatic Fever: Secondary Prophylaxis: 
Penicillin 250mg/12hrs Oral
Duration without carditis: 5 years
Duration with carditis: 10 years
Duration with carditis & persistent valvular disease: until 40 yrs old.