Acute Rheumatic Fever

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CLINICAL DESCRIPTION

Multisystem condition resulting from immune response to group B streptococcus throat infection.

CLINICAL FEATURES

SIGNS AND SYMPTOMS 

New revised Jones criteria

  1. Evidence of preceding Group A strep throat infection
  2. Major criteria
    1. Carditis
    2. Polyarthritis/polyarthralgia
    3. Subcutaneous nodules
    4. Erythema marginatum
    5. Sydenham’s chorea
  3. Minor criteria
    1. Fever >38°C
    2. Raised acute phase reactants, ESR>30mm/hr., CRP>3
    3. Prolonged PR interval
    4. Monoarthralgia

  • To make diagnosis you need one major and 2 minor or 2 major or 3 minor criteria

INVESTIGATIONS

  • FBC, ESR, CRP, Anti-Streptolysin O titer, Throat swab, ECG, Echocardiograph

TREATMENT 

PHARMACOLOGICAL 

Acute management

  • Penicillin V Potassium <5 years 250mg PO 6 hourly, >5 years 500mg BD for 10 days
  • Aspirin 25mg/kg 6 hourly for at least 14 days

If persistent fevers, joint pains consider steroids

  • Bedrest for 14 days
  • Chorea: Haloperidol 25 micrograms/kg daily
  • If not responding, sodium valproate 20mg/kg twice daily, titrate according to response
  • or Phenobarbital 5mg/kg once daily

Long term 

  • Antibiotic prophylaxis, Benzathine Penicillin 0.6MU IM < 30kg, 1.2MU > 30kg IM STAT monthly
  • Follow up in pediatric clinic

Complications 

  • Rheumatic heart disease
  • Valvular damage

Referral 

  • Children with complications of acute rheumatic fever
  • Children with Persistent symptoms