Rheumatic fever Ix and Mx

Question 1

Name 3 major investigations

Answer 1

1. Throat swab for bacterial culture
2. Bloods for - ASO antibody titres / ESR / CRP
3. Echocardiogram, ECG and chest xray can assess the heart involvement

Question 2

What is the significance of ASO antibodies?

Answer 2

1. Anti-streptococcal antibodies (ASO) are antibodies against streptococcus.
2. They indicate a recent streptococcus infection and can be helpful in supporting a diagnosis of rheumatic fever.

After an acute infection the levels usually:

Rise over 2 – 4 weeks

Gradually falls over 3 – 12 months

3. ASO levels are usually repeated after 2 weeks to:
   - Confirm a negative test
   - Assess whether levels are rising or falling

Question 3

How is streptococcal infection managed?

Answer 3

IM Benzylpenicillin for 10 days

Question 4

How are clinical features of Rheumatic fever Mx?

Answer 4

1. NSAID and Asprin - pain relief
2. Oral prednisolone
3. Prophylactic Abx to prevent further reoccurence

Question 5

What is the criteria for diagnosis of Rheumatic fever?

Answer 5

Jone’s criteria

1. 2 major criteria
2. 1 minor or 2 minor criteria

Question 6

Name 4 major symptoms in diagnosis?

Answer 6

J – Joint arthritis

O – Organ inflammation, such as carditis

N – Nodules

E – Erythema marginatum rash

S – Sydenham chorea (irregular shaking)

Question 7

Name 4 minor symptoms in diagnosis?

Answer 7

1. Fever
2. ECG Changes (prolonged PR interval) without carditis
3. Arthralgia without arthritis
4. Raised inflammatory markers (CRP and ESR)

Question 8

What is the major complication of Rheumatic fever?

Answer 8

Mitral stenosis