Rheumatic Fever

Question 1

Define rheumatic fever

Answer 1

Inflammatory multisystem disorder caused by Group A beta-haemolytic streptococci
infection

Question 2

What are the causes/risk factors of rheumatic fever?

Answer 2

Autoimmune disease: molecular mimicry -> cross-reactive antibodies and T-cells -> tissue
inflammation
• Family history

Question 3

What are the signs and symptoms of rheumatic fever?

Answer 3

General
• Fever
• Malaise
• Anorexia
• Recent sore throat (pharyngeal streptococcal infection)

Carditis
• SOB
• Chest pain
• Palpitations
• Mid-diastolic murmur
• Pericardial rub

PolyArthritis
• Painful swollen joints
• Redness
• Tenderness
Subcutaneous Nodules
• Extensor surfaces, joints, tendons
Erythema marginatum
• Transient erythematous rash with raised edges
• Crescent or ring shaped
• Trunk and proximal limbs

Sydenham’s chorea
• Rapid involuntary irregular movements with dancing quality

Question 4

What investigations are carried out for rheumatic fever?

Answer 4

• erythrocyte sedimentation rate (ESR) -≥60 mm/hour (low-risk populations) or ≥30 mm/hour (moderate- to high-risk populations) is taken as evidence of elevated inflammatory markers (minor criterion)
• CRP - ≥28.57 nanomols/L (≥3 mg/dL) is taken as evidence of elevated inflammatory markers (minor criterion)
• WBC count - may be elevated, but not recommended as meeting the minor criterion
• blood cultures - no growth
• electrocardiogram - prolonged PR interval is a minor criterion of acute rheumatic fever
• chest x-ray -may demonstrate chamber enlargement and congestive cardiac failure
• echocardiogram - may reveal morphological changes to the mitral and/or aortic valves; severity of regurgitation (mitral, aortic, and tricuspid); pericardial effusion if pericarditis present
• throat culture - growth of beta-haemolytic group A streptococci
• rapid antigen test for group A streptococci - positve
• anti-streptococcal serology - above normal range (region dependent)