Rheumatic Fever
exp date isn't null, but text field is
A systemic connective tissue disease which follows a streptococcal upper respiratory tract infection. It may involve the heart, joints, skin, subcutaneous tissue, and CNS. The first attack usually occurs between ages of 3–15 years.
Causes
- Hypersensitivity reaction to group A streptococcal throat infection
Clinical Features
- Arthritis (migrating asymmetric polyarthritis)
- Acute rheumatic carditis, signs of cardiac failure, murmurs and pericarditis
- Subcutaneous nodules
- Chorea (involuntary movements of limbs)
- Skin rash
- Other minor signs/symptoms: fever, arthralgia, laboratory findings
Differential Diagnosis
- Any form of arthralgia/arthritis including sickle cell disease, haemophilia
- Pyrexia with cardiac failure
Investigations
- Blood: Haemogram (raised ESR)
- Chest X-ray
- ECG
- Echocardiography
- Antistreptolysin O titre (ASOT)
Diagnostic Criteria (revised Jones criteria)
- Evidence of recent streptococcal infection
- Elevated ASO-titer or other streptococcal Ab titres or positive throat swab for group A beta-hemolyticus streptococcus
PLUS
- Two major manifestations or one major and two minor manifestations
MAJOR MANIFESTATIONS |
MINOR MANIFESTATIONS |
|
|
Management of stable angina
TREATMENT | LOC |
To eradicate any streptococci:
To treat the inflammation
Plus magnesium trisilicate compound 2-4 tablets every 8 hours Taken 30 minutes after the acetylsalicylic acid tablets If allergic to aspirin
|
HC4 |
If carditis/heart failure symptoms
If chorea: Valproate 10-20 mg/kg/day |
|
Prophylaxis To prevent further episodes
Or
If allergic to penicillin:
Duration of prophylaxis depends on severity of disease:
Carditis with residual heart disease: until age 40- 45 years or for life |
HC3 |
Prevention
- Early diagnosis and treatment of group A Streptococcus throat infection
- Avoid overcrowding, good housing
- Good nutrition