Rheumatic Fever: Criteria

Question 1

What is rheumatic fever?

Answer 1

An immunological reaction to a recent (2-6 weeks ago) Streptococcus pyogenes a.k.a. Lancefield Group A streptococci.

Question 2

How is it diagnosed?

Answer 2

2 major criteria

or

1 major + 2 minor criteria

Question 3

What are the major criteria?

Answer 3

• Erythema marginatum
• Sydenham’s chorea - rapid, uncoordinated jerking movements primarily affecting the face, hands and feet. Mostly affects children.
• Polyarthritis
• Carditis (endo-, myo- or peri-)
• Subcutaneous nodules

Question 4

What is this?

Answer 4

Erythema marginatum

Question 5

What are the minor criteria?

Answer 5

• Raised ESR or CRP
• Pyrexia
• Arthralgia (not if arthritis a major criteria)
• Prolonged PR interval

Question 6

What investigations can you do if you suspect

Answer 6

• ASOT > 200iu/mL
• History of scarlet fever
• Positive throat swab
• Increase in DNase B titre

Question 7

A 13-year-old male presents with a fever and flitting joint pains following a sore throat. He has recently moved from Kuwait to the United Kingdom with his family. On examination he is found to have a systolic murmur.

• Atrial myxoma
• Cardiac arrhythmia
• Cardiac contusion
• Cardiac failure
• Cardiomyopathy
• Endocarditis
• Ischaemic heart disease
• Myocarditis
• Rheumatic heart disease

Answer 7

Rheumatic heart disease

Rheumatic heart disease is an inflammatory disease which follows infection with Lancefield group A streptococci, affecting the heart, skin, joints and central nervous system. It is caused by an inappropriate immune response to streptococcal antigens.