Rheumatic Fever Flashcards
Define Rheumatic Fever
Inflammatory multisystem disorder that arises as a delayed complication of an URTI with group A beta-haemolytic streptococci
What is chronic rheumatic fever
Scarring and chronic inflammation of the heart and valves -> heart failure, murmurs and damage to the valves
Aetiology of Rheumatic Fever
Recur unless prevented
Pharyngeal infection triggers fever 2-4 weeks later
Though to be due to molecular mimicry: antibody to the cell wall of the streptococcus cross-reacts with valve tissue
Risk factors for rheumatic fever
Age (4-9) Female Overcrowded living quarters Family history D8/17B cell antigen positivity
Epidemiology for Rheumatic Fever
Common in developing countries, increasingly rare in the rest
Peak incidence 5-15
Presenting symptoms of rheumatic fever
2-5 weeks AFTER a sore throat
Malaise, fever Anorexia Joint pain and swelling Reduced movement Breathlessness, chest pain, palpitations
Signs of Rheumatic fever (major)
Carditis: tachycardia, regurgitation, pericardial rub, cardiomegaly, systolic murmur
Arthritis: polyarthritis usually in larger joints
Subcutaneous nodules: small, mobile, painless on joints and spine
Erythema marginatum: raised edged red rash with clear centre
Syndenham’s chorea: involuntary movements
Minor criteria for rheumatic fever
Fever Raised ESR or CRP Previous rheumatic fever Previous infection with group A b-haemolytic strep Prolonged PR or QT interval Arthralgia
Criteria used for Rheumatic Fever
Jones’ criteria
Group A strep infection + 2 major criteria
OR
1 major and two minor criteria
Investigations for rheumatic fever
Throat swab: +ve GABH-strep
ECG: prolonged PR/QT and pericarditis changes
Rapid antigen test: +ve
FBC: WCC raised
ESR + CRP: raised
Anti-streptococcal serology/antistreptolysin (ASO): raised/rising
CXR: Chamber enlargement and congestive heart failure
Echo: Changes to the valves, severity of regurgitation, pericardial effusion, chordal thickening
