Acute Rheumatic Fever Overview Part 3

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Questions and Answers

What is the minimum requirement for a diagnosis based on Jones criteria?

2 major criteria only

2 major criteria or 1 major and 2 minor criteria (correct)

1 major criterion alone

At least 3 major criteria

In the presence of heart failure, how long is bed rest recommended?

4 weeks

6 weeks

2 weeks

8 weeks (correct)

What is the first choice antibiotic for treating streptococcal infection?

Co-trimoxazole

Naproxen

Erythromycin

Benzyl penicillin (correct)

Which of the following is an alternative for patients with a penicillin allergy?

Co-trimoxazole Signup and view all the answers

What is the maximum dose of aspirin per day for treating Acute Rheumatic Fever without carditis?

16 tablets Signup and view all the answers

What dietary restriction is advised in the presence of heart failure?

Salt and fluid restriction Signup and view all the answers

Which symptom is the earliest sign of aspirin toxicity?

Tachypnea Signup and view all the answers

For how long should the aspirin dosage be maintained at 1000 mg/kg/d until clinical manifestations subside?

2 weeks Signup and view all the answers

What is the initial corticosteroid dose for treating severe carditis in RF?

2 mg/kg/d Signup and view all the answers

Why should aspirin not be used in the presence of carditis?

It increases myocardial oxygen consumption. Signup and view all the answers

What is the recommended prophylaxis duration for mild carditis?

3 years from the last episode Signup and view all the answers

In the treatment of ARF with tuberculosis, what is a critical precaution regarding corticosteroids?

They can worsen TB infection and should be avoided. Signup and view all the answers

What is the appropriate dose and frequency of benzathine penicillin for prophylaxis in RF?

1,200,000 IU every 3-4 weeks Signup and view all the answers

What special consideration should be taken when using digoxin for ARF with CHF?

Use with caution to avoid arrhythmia. Signup and view all the answers

In the case of ARF with diabetes, what should be adjusted when corticosteroids are necessary?

Insulin dosage Signup and view all the answers

What is a recommended method for administering salicylates to patients with peptic ulcers?

As enteric-coated preparations. Signup and view all the answers

What percentage of patients typically exhibit carditis as a major criterion of rheumatic fever?

50% Signup and view all the answers

Which of the following is NOT considered a major criterion for rheumatic fever?

Fever Signup and view all the answers

Which manifestation is most commonly associated with rheumatic chorea?

Jerky limb movements Signup and view all the answers

What is the prevalence of erythema marginatum as a major criterion in rheumatic fever?

1% Signup and view all the answers

Which of the following features is associated with the acute phase of carditis in children?

Increased C-reactive protein Signup and view all the answers

How does polarthritis typically present in patients with rheumatic fever?

Fleeting and migratory joint swelling Signup and view all the answers

Which of the following laboratory findings would likely indicate heightened immune response in a patient suspected of rheumatic fever?

Elevated ASO titre Signup and view all the answers

What is the typical characteristic of subcutaneous nodules seen in rheumatic fever?

Painless and located beside muscle tendons Signup and view all the answers

What is the underlying cause of Acute Rheumatic Fever?

Autoimmune response due to antibody cross-reactivity Signup and view all the answers

Which age group has the highest incidence of Acute Rheumatic Fever?

Children aged 5-15 years Signup and view all the answers

What type of bacteria is associated with the initial infection that can lead to Acute Rheumatic Fever?

Group A β-hemolytic Streptococcus Signup and view all the answers

Which environmental factor is NOT associated with increased risk for Acute Rheumatic Fever?

High socioeconomic status Signup and view all the answers

What is one of the surface antigens implicated in the autoimmune response in Acute Rheumatic Fever?

M protein Signup and view all the answers

Which factor does NOT influence the pathogenesis of Acute Rheumatic Fever?

Sex of the individual Signup and view all the answers

What role does molecular mimicry play in the development of Acute Rheumatic Fever?

It results in antibodies targeting host tissues that resemble bacterial antigens. Signup and view all the answers

Which characteristic of Acute Rheumatic Fever is indicative of autoimmune involvement?

Presence of hyaluronic acid in tissues Signup and view all the answers

Antibodies formed against antigens can cross-react with connective tissue antigens in the heart and skin.

True Signup and view all the answers

The major criteria for rheumatic fever include a fever as a primary indicator.

False Signup and view all the answers

Rheumatic chorea occurs more frequently in boys compared to girls.

False Signup and view all the answers

Erythema marginatum is a type of painless nodules associated with rheumatic fever.

False Signup and view all the answers

The occurrence of carditis in rheumatic fever patients is approximately 50%.

True Signup and view all the answers

Antistreptolysin O titre is regarded as a minor criterion for the diagnosis of rheumatic fever.

True Signup and view all the answers

Painless subcutaneous nodules are more commonly found on muscle tendons in patients with rheumatic fever.

True Signup and view all the answers

The rebound of joint swelling in arthritis is often permanent, leading to deformity.

False Signup and view all the answers

Corticosteroids are preferred over aspirin in the treatment of carditis due to their ability to prevent pericardial rub.

True Signup and view all the answers

High doses of aspirin decrease myocardial oxygen consumption and heart workload, thereby reducing the risk of valvular lesions.

False Signup and view all the answers

The recommended prophylaxis duration for moderate carditis is until the patient reaches 21 years of age.

True Signup and view all the answers

Benzathine penicillin is given at a dose of 1,200,000 IU every two weeks for the treatment of ARF.

False Signup and view all the answers

In the treatment of ARF with diabetes, insulin doses must be adjusted to prevent hyperglycemia when using corticosteroids.

True Signup and view all the answers

Corticosteroids can be safely used in patients with tuberculosis without any precautions.

False Signup and view all the answers

Fluid and salt restriction is not recommended for ARF patients with congestive heart failure.

False Signup and view all the answers

Salicylates should be administered in enteric-coated preparations to minimize gastric irritation.

True Signup and view all the answers

Acute Rheumatic Fever (ARF) may occur as a complication of poorly treated Group A β-hemolytic streptococcal infection.

True Signup and view all the answers

The incidence of Acute Rheumatic Fever is higher in males compared to females.

False Signup and view all the answers

The autoimmune response in Acute Rheumatic Fever is primarily triggered by antibody cross-reactivity due to molecular mimicry.

True Signup and view all the answers

Genetic factors have no relevance in the incidence of Acute Rheumatic Fever.

False Signup and view all the answers

Acute Rheumatic Fever can develop in children as young as 1 year old.

False Signup and view all the answers

Hyaluronic acid is considered one of the surface antigens associated with Acute Rheumatic Fever.

True Signup and view all the answers

Poor living conditions and overcrowding do not influence the risk of developing Acute Rheumatic Fever.

False Signup and view all the answers

The autoimmune nature of Acute Rheumatic Fever has no connection with streptococcal infections of the upper respiratory tract.

False Signup and view all the answers

Antibiotics are administered to eradicate streptococcal infection, with benzylpenicillin being the first choice.

True Signup and view all the answers

Aspirin should be avoided in the treatment of Acute Rheumatic Fever without carditis.

False Signup and view all the answers

In the presence of heart failure, at least 8 weeks of bed rest is recommended.

True Signup and view all the answers

Naproxen is the first choice for patients who are allergic to aspirin when treating Acute Rheumatic Fever.

False Signup and view all the answers

The ASO titer should exceed 400 U as a diagnostic measure for rheumatic fever.

True Signup and view all the answers

Salicylates can be administered for a maximum of 16 tablets per day under any circumstances.

False Signup and view all the answers

Fluid restriction is advised only during the presence of heart failure in acute rheumatic fever patients.

True Signup and view all the answers

Rapid breathing is considered the earliest sign of aspirin toxicity in treating acute rheumatic fever.

True Signup and view all the answers

What is the dosage reduction plan for corticosteroids in severe carditis after clinical manifestations subside?

After 2 weeks at 2 mg/kg/d, reduce the dose to 1 mg/kg/d for one month. Signup and view all the answers

What is the rationale behind the use of long-acting penicillin for prophylaxis in rheumatic fever?

Long-acting penicillin prevents recurrence of rheumatic fever by eliminating streptococcal infection. Signup and view all the answers

How long should prophylaxis with benzathine penicillin continue for a patient with severe carditis?

Lifelong prophylaxis is recommended for patients with severe carditis or recurrent episodes. Signup and view all the answers

Why are corticosteroids avoided in patients with ARF and tuberculosis?

Corticosteroids are immunosuppressants that can exacerbate TB infections. Signup and view all the answers

What special considerations should be made for administering digoxin in ARF patients with CHF?

Digoxin should be used with caution to avoid arrhythmia due to the heart's sensitivity during rheumatic activity. Signup and view all the answers

What factors must be considered when using corticosteroids in ARF patients with diabetes?

Adjustments in insulin doses are necessary to prevent hyperglycemia caused by corticosteroids. Signup and view all the answers

What is the significance of polyrhritis in the context of Acute Rheumatic Fever, and how does it typically present?

Polyrhritis is a major criterion in Acute Rheumatic Fever, characterized by swelling and tenderness of large joints, often fleeting and migratory. Signup and view all the answers

How should salicylates be administered to ARF patients with peptic ulcers to minimize gastric irritation?

Salicylates should be given enteric-coated or through multiple routes after meals with plenty of fluids. Signup and view all the answers

What is the significance of cardiovascular effects when using high doses of aspirin in the context of carditis?

High doses of aspirin increase myocardial oxygen consumption, worsening cardiac workload and potential heart failure. Signup and view all the answers

Describe the role of antibodies in the autoimmune response seen in Acute Rheumatic Fever.

Antibodies formed against streptococcal antigens cross-react with connective tissue antigens in various body parts, including the heart. Signup and view all the answers

Explain the importance of the Antistreptolysin O titre in diagnosing Acute Rheumatic Fever.

The Antistreptolysin O titre is a minor criterion that indicates the presence of streptococcal infection by measuring immune response levels. Signup and view all the answers

What are the clinical manifestations of rheumatic chorea, and which demographic is primarily affected?

Rheumatic chorea is characterized by jerky limb movements and emotional instability, occurring more frequently in girls than boys. Signup and view all the answers

Identify the major systemic effect of carditis as observed in Acute Rheumatic Fever patients.

Carditis can lead to murmurs, arrhythmias, and cardiomegaly, with approximately 50% of rheumatic fever patients experiencing this condition. Signup and view all the answers

How do subcutaneous nodules appear in patients with rheumatic fever, and where are they typically located?

Subcutaneous nodules are painless and typically located beside muscle tendons in patients with rheumatic fever. Signup and view all the answers

What is the relationship between fever and the minor criteria for diagnosing Acute Rheumatic Fever?

Fever is a minor criterion that indicates an inflammatory response, often accompanying other symptoms of rheumatic fever. Signup and view all the answers

Discuss the reversibility of rheumatic chorea symptoms in relation to treatment outcomes.

Rheumatic chorea symptoms are generally reversible with appropriate treatment, allowing full recovery of motor function. Signup and view all the answers

Under what circumstances should antipyretic treatment be prioritized in children with rheumatic fever?

Antipyretic treatment should be prioritized in children with rheumatic fever who exhibit high fever or discomfort due to inflammatory symptoms. Signup and view all the answers

What is the mechanism by which aspirin alleviates inflammation in Acute Rheumatic Fever?

Aspirin alleviates inflammation by inhibiting cyclooxygenase enzymes, which decreases the production of prostaglandins involved in the inflammatory response. Signup and view all the answers

Discuss the reasons for choosing benzylpenicillin over other antibiotics for streptococcal infections in rheumatic fever.

Benzylpenicillin is the first choice due to its efficacy in eradicating Group A β-hemolytic streptococci and its established safety profile. Signup and view all the answers

What role does dietary modification play in the management of Acute Rheumatic Fever with carditis?

Dietary modification, specifically salt and fluid restriction, helps prevent volume overload and manage symptoms in patients with carditis. Signup and view all the answers

How is the prescribing of salicylates adjusted in patients experiencing aspirin toxicity?

In cases of aspirin toxicity, the prescribed doses should be reduced or discontinued immediately to prevent further complications. Signup and view all the answers

Why is it necessary to confirm a previous streptococcal infection when diagnosing rheumatic fever?

Confirming a previous streptococcal infection is necessary because it establishes the link between infection and the autoimmune response that leads to rheumatic fever. Signup and view all the answers

What are the implications of administering corticosteroids to patients with rheumatic fever and concomitant tuberculosis?

Corticosteroids can exacerbate tuberculosis; therefore, careful monitoring and alternative treatments may be required in these patients. Signup and view all the answers

Describe the significance of elevated ASO titers in diagnosing rheumatic fever.

Elevated ASO (Antistreptolysin O) titers indicate a recent streptococcal infection, which is a key part of the diagnostic criteria for rheumatic fever. Signup and view all the answers

What is the primary mechanism by which Acute Rheumatic Fever develops following a Group A β-hemolytic streptococcal infection?

It develops due to autoimmune responses caused by antibody cross-reactivity. Signup and view all the answers

Identify one environmental factor that can increase the incidence of Acute Rheumatic Fever.

Poor living conditions. Signup and view all the answers

At what ages does Acute Rheumatic Fever most commonly occur?

It most commonly occurs in individuals aged 5 to 15 years. Signup and view all the answers

What role does molecular mimicry play in the pathogenesis of Acute Rheumatic Fever?

Molecular mimicry allows antibodies against streptococcal antigens to recognize and attack host tissues. Signup and view all the answers

Explain how genetic factors might influence the severity of Acute Rheumatic Fever.

Genetic factors may predispose individuals to heightened immune responses or susceptibility to autoimmune reactions. Signup and view all the answers

Name one of the surface antigens on the GABHS that is thought to trigger an autoimmune response in Acute Rheumatic Fever.

M protein. Signup and view all the answers

What is the significance of age as a risk factor in the incidence of Acute Rheumatic Fever?

Age is critical since ARF most commonly affects children aged 5-15, indicating a developmental susceptibility. Signup and view all the answers

Describe the impact of overcrowding on the incidence of Acute Rheumatic Fever.

Overcrowding facilitates the spread of streptococcal infections, increasing the risk of ARF development. Signup and view all the answers

At least 2 major criteria must be present OR 1 major + 2 minor criteria PLUS evidence of previous ______ infection.

streptococcal Signup and view all the answers

The first choice antibiotic to eradicate streptococcal infection is ______.

benzylpenicillin Signup and view all the answers

In the presence of heart failure, bed rest is recommended for ______ weeks.

8 Signup and view all the answers

Aspirin cannot prevent pericardial rub or valve deformity, but ______ can.

steroids Signup and view all the answers

Using high doses of aspirin can increase myocardial O2 consumption and precipitate ______ lesions.

valvular Signup and view all the answers

For patients who are allergic to aspirin, ______ is an alternative anti-inflammatory medication.

naproxen Signup and view all the answers

Dietary recommendations include salt and fluid restriction in the presence of ______ or heart failure.

carditis Signup and view all the answers

For severe carditis or recurrent episodes of RF, prophylaxis is required for ______.

lifelong Signup and view all the answers

The dose of benzathine penicillin for prophylaxis in RF is 1,200,000 IU every ______ weeks.

3-4 Signup and view all the answers

Salicylates should be administered in enteric-coated preparations to minimize ______ irritation.

gastric Signup and view all the answers

In the presence of tuberculosis, corticosteroids must be used under the umbrella of ______ drugs.

antituberculous Signup and view all the answers

Elevated ASO titer greater than ______ U is one of the laboratory indicators for rheumatic fever.

400 Signup and view all the answers

In the treatment of ARF with carditis, the recommended aspirin dosage is ______ mg/kg/d for 2 weeks.

1000 Signup and view all the answers

For mild carditis, prophylaxis duration is for ______ years from the last episode.

3 Signup and view all the answers

Fluid and salt restriction is important for patients with ARF and ______.

CHF Signup and view all the answers

Corticosteroids are preferred over aspirin in treating carditis due to their ability to prevent ______ rub.

pericardial Signup and view all the answers

Antibodies formed against these antigens can cross-react with connective tissue antigens in the heart and ___ tissues.

subcutaneous Signup and view all the answers

The major criteria for rheumatic fever include polarthritis, carditis, and rheumatic ___.

chorea Signup and view all the answers

Acute carditis in children is often accompanied by an increase in C-reactive ___ and ESR.

protein Signup and view all the answers

Fever, arthralgia, and an increased PR interval in the ECG are considered ___ criteria for rheumatic fever.

minor Signup and view all the answers

The Jones criteria for diagnosing rheumatic fever was first published in ___ .

1944 Signup and view all the answers

Subcutaneous nodules are typically painless and located beside ___ tendons.

muscle Signup and view all the answers

Erythema marginatum is characterized by red patches over the limbs and ___.

trunk Signup and view all the answers

Repeated streptococcal infection is required for sensitization of the ___ system.

immune Signup and view all the answers

Acute Rheumatic Fever may develop as a complication of poorly treated Group A β-hemolytic streptococcal infection of the ______.

URT Signup and view all the answers

The disease is caused by antibody cross-reactivity, which is a type of ______ disease.

autoimmune Signup and view all the answers

The age group most commonly affected by Acute Rheumatic Fever is ______ years.

5-15 Signup and view all the answers

Genetic factors may ______ a role in the incidence of Acute Rheumatic Fever.

play Signup and view all the answers

The autoimmune theory involves molecular ______ where the immune system reacts to host tissues.

mimicry Signup and view all the answers

Group A β-hemolytic streptococcal infections usually follow infections of the ______.

URT Signup and view all the answers

Surface antigens such as hyaluronic acid and M protein are considered ______ agents in the pathogenesis of Acute Rheumatic Fever.

immunogenic Signup and view all the answers

The occurrence of Acute Rheumatic Fever has been linked to poor living ______.

conditions Signup and view all the answers

Match the treatment options with their specific indications in Acute Rheumatic Fever:

Aspirin = ARF without carditis Benzyl penicillin = Eradicate streptococcal infection Naproxen = Alternative for aspirin allergy Salt restriction = In presence of heart failure Signup and view all the answers

Match the clinical findings with their corresponding criteria in the diagnosis of rheumatic fever:

Elevated ASO titer = Supporting evidence of previous streptococcal infection History of pharyngitis = Major diagnostic criterion Tachypnea = Earliest sign of aspirin toxicity Heart failure = Management indication for extended bed rest Signup and view all the answers

Match the dosage guidelines with their respective medications in the management of Acute Rheumatic Fever:

1000 mg/kg/d = Initial dose of aspirin 75 mg/kg/d = Second phase dose of aspirin 50 mg/kg/d = Final phase dose of aspirin 1 million IU/6h = Dosing schedule for benzyl penicillin Signup and view all the answers

Match the following terms related to Acute Rheumatic Fever (ARF) with their definitions:

Antibody Cross-reactivity = Autoimmune response due to similarity between bacterial and host antigens Group A β-hemolytic streptococcus = Bacteria associated with throat infection and possible ARF Hyaluronic Acid = A surface antigen linked to autoimmune reactions in ARF Incidence Age = Most commonly affects individuals aged 5-15 years Signup and view all the answers

Match the medications with their specific roles in the management of inflammation in ARF:

Salicylates = Suppress acute inflammatory response Corticosteroids = Used in severe carditis Co-trimoxazole = Alternative for penicillin allergy Antibiotics = To eradicate streptococcus infection Signup and view all the answers

Match the following environmental factors with their descriptions in relation to ARF:

Overcrowding = Contributes to the spread of infection leading to ARF Poor living conditions = Associated with higher incidence of ARF Genetic factors = May influence individual susceptibility to ARF No sex difference = Indicates equal incidence rates of ARF between genders Signup and view all the answers

Match the following major criteria for Acute Rheumatic Fever with their associated characteristics:

Fever = Primary indicator of ARF Carditis = Inflammation of the heart, a serious complication of ARF Arthritis = Pain and swelling of joints as a major manifestation Chorea = Neurological manifestation frequently observed in ARF patients Signup and view all the answers

Match the management recommendations with their corresponding clinical scenarios in Acute Rheumatic Fever:

2 weeks = Bed rest without carditis 4 weeks = Bed rest with carditis 8 weeks = Bed rest with heart failure Dietary fluid restriction = Presence of heart failure or carditis Signup and view all the answers

Match the following autoimmune theory concepts with their explanations:

Molecular Mimicry = Mechanism where antibodies target body tissues due to similarity with pathogens Surface Antigens = Molecular features of GABHS that resemble human tissues Inflammatory Disease = General term for conditions caused by immune response such as ARF Antigenic Variation = Potential alteration of bacteria that affects immune response Signup and view all the answers

Match the potential complications with their respective contributing factors in Acute Rheumatic Fever:

Carditis = Major criterion of rheumatic fever Chorea = Neurological manifestation linked to rheumatic fever Erythema marginatum = Skin rash associated with rheumatic fever Subcutaneous nodules = Indicator of ongoing inflammation Signup and view all the answers

Match the patient management considerations with the corresponding comorbid conditions in rheumatic fever:

Corticosteroid adjustments = In patients with diabetes Fluid volume management = In presence of heart failure Aspirin toxicity monitoring = In patients with high dosing Antibiotic preference = In patients with penicillin allergies Signup and view all the answers

Match the following risk factors with their descriptions related to Acute Rheumatic Fever:

Environmental = Conditions that exacerbate the spread of streptococcal infections Genetic = Inherited traits that may predispose an individual to ARF Age = Specific demographic most at risk for developing ARF Sex = Factor that does not influence ARF incidence or pathogenesis Signup and view all the answers

Match the following aspects of Acute Rheumatic Fever with their significance:

Untreated infections = Key trigger leading to the development of ARF Symptom onset = Typically follows a sore throat episode caused by streptococcus Antistreptolysin O titre = Laboratory test used to support diagnosis of ARF Chronic complications = Long-term risks after initial ARF episodes, including valvular damage Signup and view all the answers

Match the diagnostic criteria with their associated characteristics in rheumatic fever:

Major criteria = At least 2 must be present Minor criteria = 1 major + 2 minor required Previous streptococcal infection = Evidence for diagnosis Elevated ASO titer = Indicator of immune response Signup and view all the answers

Match the following complications or manifestations of rheumatic fever with their descriptors:

Subcutaneous nodules = Painless lumps found over joints and tendons Erythema marginatum = Specific skin rash associated with ARF Heart failure = Potential outcome of severe carditis in ARF patients Polyarthritis = Multiple joint involvement typically seen in rheumatic fever Signup and view all the answers

Match the following statements about the pathophysiology of Acute Rheumatic Fever with their implications:

Autoimmune Disease = Condition resulting from an immune response to self-tissues Host Tissue Similarity = Relationship between bacterial antigens and human tissues leading to ARF Complication of URT infection = Common source for the initiation of ARF development Incidence equal across genders = Indicates that ARF affects males and females similarly Signup and view all the answers

Match the following major criteria of rheumatic fever with their descriptions:

Polarthritis = Swollen and tender joints that are migratory and do not cause deformity Carditis = Includes murmurs and may lead to arrhythmia and pericardial rub Rheumatic chorea = Jerky limb movements primarily occurring in girls with emotional instability Subcutaneous nodules = Painless nodules typically located beside muscle tendons Signup and view all the answers

Match the following minor criteria of rheumatic fever with their indicators:

Fever = Elevated body temperature indicating infection or inflammation Arthralgia = Pain in the joints that does not usually present with swelling ↑ PR interval = Prolongation of the time between heartbeats observed on ECG ↑ Antistreptolysin O titre = Indicates previous streptococcal infection activity Signup and view all the answers

Match the following symptoms with their associated percentages of occurrence in rheumatic fever:

Carditis = 50% occurrence Polarthritis = 70% occurrence Erythema marginatum = 1% occurrence Rheumatic chorea = 10% occurrence Signup and view all the answers

Match the following laboratory findings with their relevance in rheumatic fever:

↑ C-reactive protein = Indicator of inflammation in the body ↑ ESR = Reflects the rate of inflammation in the bloodstream ↑ Antistreptolysin O titre = Signifies recent streptococcal infection ECG changes = May indicate underlying cardiac involvement Signup and view all the answers

Match the following statements about rheumatic fever with their accuracy:

Antibodies formed against antigens = Can cross-react with connective tissue antigens Major criteria include fever = False; fever is a minor criterion Carditis affects 50% of patients = True; this is a significant occurrence Chorea occurs more in boys = False; it is more prominent in girls Signup and view all the answers

Match the following treatments with their indications in rheumatic fever:

Aspirin = Used to reduce inflammation and pain in carditis Corticosteroids = Preferred for severe carditis to reduce immune response Benzathine penicillin = Recommended prophylaxis for preventing streptococcal infections Salicylates = Given in enteric-coated form to minimize gastrointestinal irritation Signup and view all the answers

Match the following statements about the immune response in rheumatic fever with their implications:

Molecular mimicry = Explains the autoimmune aspects of the disease Repeated streptococcal infection = Necessary for the sensitization of the immune system Heart involvement = Often due to antibodies reacting with heart tissue Connective tissue exposure = Can trigger autoimmune reactions against the body's own tissues Signup and view all the answers

Match the following autoimmune aspects with their consequences in rheumatic fever:

Cross-reactivity = Leads to inflammation in connective tissues Leukocyte activation = Results in increased inflammatory markers Chronic rheumatic heart disease = Can develop from untreated acute rheumatic fever Paternal inheritance = Does not significantly influence the risk of developing rheumatic fever Signup and view all the answers

Match the following treatment considerations with their specific conditions during Acute Rheumatic Fever (ARF):

Corticosteroids = Must be used under umbrella of antituberculous drugs if necessary Digoxin = Use with caution to avoid arrhythmia in CHF Salicylates = Administer in enteric-coated preparations to minimize gastric irritation Benzathine penicillin = Given every 3-4 weeks for prophylaxis Signup and view all the answers

Match the following severity of carditis with their duration of prophylaxis for ARF:

Mild carditis = 3 years from last episode Moderate carditis = Till 21 years old Severe carditis = Lifelong prophylaxis Recurrent episodes of RF = Lifelong prophylaxis Signup and view all the answers

Match the following effects of aspirin and corticosteroids in the treatment of carditis:

Aspirin = Increases myocardial oxygen consumption Corticosteroids = Immunosuppressant properties Signup and view all the answers

Match the following proposed actions in ARF management with the conditions they correspond to:

Fluid and salt restriction = ARF with CHF Adjust insulin dosage = ARF with diabetes Avoid corticosteroids = ARF with tuberculosis Use H2 blockers = ARF with peptic ulcer Signup and view all the answers

Match the following complications or characteristics of ARF with their corresponding descriptions:

Pericardial rub = Can be prevented by corticosteroids Myocardial O2 consumption = Increased by high doses of aspirin Flaring of TB infection = Risk when corticosteroids are used Gastric irritation = Minimized by using enteric-coated salicylates Signup and view all the answers

Match the following medications with the reasons why they are specified in the treatment of acute rheumatic fever:

Corticosteroids = Preferred for severe carditis Benzathine penicillin = First-line prophylaxis against rheumatic fever recurrence Salicylates = Used for symptomatic relief but not preferred in carditis Digoxin = Used cautiously in CHF Signup and view all the answers

Match the following corticosteroid dosages with their duration in treating severe carditis:

2 mg/kg/d = First 2 weeks 1 mg/kg/d = Next month Lifelong prophylaxis = Severe carditis recurrence 3 years = Mild carditis prophylaxis Signup and view all the answers

Match the following treatment strategies with their research-backed precautions in ARF management:

Use corticosteroids cautiously = In ARF with TB Fluid restriction = In ARF with CHF Insulin dosage adjustment = In ARF with diabetes when using corticosteroids Salicylate use = Should be given after meals to avoid irritation Signup and view all the answers

Study Notes

Acute Rheumatic Fever (ARF) Definition

Inflammatory disease from untreated or poorly treated Group A β-hemolytic streptococcal infection in the upper respiratory tract.
Caused by antibody cross-reactivity in an autoimmune process.

Incidence

Predominantly affects ages 5-15 years; rare in ages 2-5.
Environmental factors: Poor living conditions and overcrowding contribute.
Genetic predisposition may also play a role.
Incidence and pathogenesis do not differ by sex.

Etiology and Pathogenesis

Follows upper respiratory tract infections with GABHS.
Disease linked to surface antigens (hyaluronic acid, M protein) that resemble host tissues.
Antibodies against these antigens can target connective tissues in the heart, synovial membranes, and skin.
Repeated streptococcal infections sensitize the immune system.

Clinical Manifestations: Jones Criteria

Major Criteria:
- Polyarthritis (70%): Swollen, tender, migratory large joints, resolves without deformity.
- Carditis (50%): Characterized by murmurs, arrhythmias, cardiomegaly, and pericardial rub.
- Rheumatic chorea (10%): Jerky movements and emotional instability, more common in girls.
- Subcutaneous nodules (5%): Painless lumps adjacent to muscles.
- Erythema marginatum (1%): Red patches on limbs and trunk.
Minor Criteria:
- Fever.
- Arthralgia: Joint pain.
- Increased PR interval on ECG.
- Elevated antistreptolysin O titer (ASO).

Diagnosis

At least two major criteria or one major plus two minor criteria required, along with evidence of prior streptococcal infection.
Confirmatory tests: Positive throat culture for GABHS, elevated ASO titers.

Management: Acute Episode

Bed rest recommended for:
- 2 weeks without cardiitis.
- 4 weeks with cardiitis.
- 8 weeks with heart failure or cardiomegaly.
Special diet: Salt and fluid restriction if cardiitis or heart failure is present.
Antibiotics to treat streptococcal infection:
- First choice: Benzylpenicillin.
- Alternative for penicillin allergy: Co-trimoxazole or erythromycin.
Anti-inflammatories for managing inflammation:
- Without carditis: Aspirin; dosing starts high and tapers.
- With severe carditis: Corticosteroids, starting at 2 mg/kg/day, reduced after symptoms subside.
Rationale for corticosteroids over aspirin in carditis: Corticosteroids can prevent serious cardiac complications which aspirin cannot.

Prevention of Recurrence Post-Acute Episode

Prophylaxis with long-acting benzathine penicillin:
- 1,200,000 IU every 3-4 weeks.
Duration of prophylaxis:
- Mild/no carditis: 3 years post-last episode.
- Moderate carditis: Continue until age 21.
- Severe carditis/recurrent RF: Lifelong treatment.

Precautions during Treatment of ARF with Other Conditions

TB: Avoid corticosteroids due to immunosuppression; use alongside antituberculous therapy if necessary.
Congestive heart failure: Implement fluid and salt restrictions; exercise caution with digoxin to prevent arrhythmias.
Diabetes: Adjust insulin if corticosteroids are used, considering possible interactions with antidiabetics.
Peptic ulcers: Administer salicylates carefully to avoid gastric irritation; use enteric-coated preparations and consider H2 blockers or proton pump inhibitors.

Acute Rheumatic Fever (ARF) Definition

Inflammatory disease from untreated or poorly treated Group A β-hemolytic streptococcal infection in the upper respiratory tract.
Caused by antibody cross-reactivity in an autoimmune process.

Incidence

Predominantly affects ages 5-15 years; rare in ages 2-5.
Environmental factors: Poor living conditions and overcrowding contribute.
Genetic predisposition may also play a role.
Incidence and pathogenesis do not differ by sex.

Etiology and Pathogenesis

Follows upper respiratory tract infections with GABHS.
Disease linked to surface antigens (hyaluronic acid, M protein) that resemble host tissues.
Antibodies against these antigens can target connective tissues in the heart, synovial membranes, and skin.
Repeated streptococcal infections sensitize the immune system.

Clinical Manifestations: Jones Criteria

Major Criteria:
- Polyarthritis (70%): Swollen, tender, migratory large joints, resolves without deformity.
- Carditis (50%): Characterized by murmurs, arrhythmias, cardiomegaly, and pericardial rub.
- Rheumatic chorea (10%): Jerky movements and emotional instability, more common in girls.
- Subcutaneous nodules (5%): Painless lumps adjacent to muscles.
- Erythema marginatum (1%): Red patches on limbs and trunk.
Minor Criteria:
- Fever.
- Arthralgia: Joint pain.
- Increased PR interval on ECG.
- Elevated antistreptolysin O titer (ASO).

Diagnosis

At least two major criteria or one major plus two minor criteria required, along with evidence of prior streptococcal infection.
Confirmatory tests: Positive throat culture for GABHS, elevated ASO titers.

Management: Acute Episode

Bed rest recommended for:
- 2 weeks without cardiitis.
- 4 weeks with cardiitis.
- 8 weeks with heart failure or cardiomegaly.
Special diet: Salt and fluid restriction if cardiitis or heart failure is present.
Antibiotics to treat streptococcal infection:
- First choice: Benzylpenicillin.
- Alternative for penicillin allergy: Co-trimoxazole or erythromycin.
Anti-inflammatories for managing inflammation:
- Without carditis: Aspirin; dosing starts high and tapers.
- With severe carditis: Corticosteroids, starting at 2 mg/kg/day, reduced after symptoms subside.
Rationale for corticosteroids over aspirin in carditis: Corticosteroids can prevent serious cardiac complications which aspirin cannot.

Prevention of Recurrence Post-Acute Episode

Prophylaxis with long-acting benzathine penicillin:
- 1,200,000 IU every 3-4 weeks.
Duration of prophylaxis:
- Mild/no carditis: 3 years post-last episode.
- Moderate carditis: Continue until age 21.
- Severe carditis/recurrent RF: Lifelong treatment.

Precautions during Treatment of ARF with Other Conditions

TB: Avoid corticosteroids due to immunosuppression; use alongside antituberculous therapy if necessary.
Congestive heart failure: Implement fluid and salt restrictions; exercise caution with digoxin to prevent arrhythmias.
Diabetes: Adjust insulin if corticosteroids are used, considering possible interactions with antidiabetics.
Peptic ulcers: Administer salicylates carefully to avoid gastric irritation; use enteric-coated preparations and consider H2 blockers or proton pump inhibitors.

Acute Rheumatic Fever (ARF) Definition

Inflammatory disease from untreated or poorly treated Group A β-hemolytic streptococcal infection in the upper respiratory tract.
Caused by antibody cross-reactivity in an autoimmune process.

Incidence

Predominantly affects ages 5-15 years; rare in ages 2-5.
Environmental factors: Poor living conditions and overcrowding contribute.
Genetic predisposition may also play a role.
Incidence and pathogenesis do not differ by sex.

Etiology and Pathogenesis

Follows upper respiratory tract infections with GABHS.
Disease linked to surface antigens (hyaluronic acid, M protein) that resemble host tissues.
Antibodies against these antigens can target connective tissues in the heart, synovial membranes, and skin.
Repeated streptococcal infections sensitize the immune system.

Clinical Manifestations: Jones Criteria

Major Criteria:
- Polyarthritis (70%): Swollen, tender, migratory large joints, resolves without deformity.
- Carditis (50%): Characterized by murmurs, arrhythmias, cardiomegaly, and pericardial rub.
- Rheumatic chorea (10%): Jerky movements and emotional instability, more common in girls.
- Subcutaneous nodules (5%): Painless lumps adjacent to muscles.
- Erythema marginatum (1%): Red patches on limbs and trunk.
Minor Criteria:
- Fever.
- Arthralgia: Joint pain.
- Increased PR interval on ECG.
- Elevated antistreptolysin O titer (ASO).

Diagnosis

At least two major criteria or one major plus two minor criteria required, along with evidence of prior streptococcal infection.
Confirmatory tests: Positive throat culture for GABHS, elevated ASO titers.

Management: Acute Episode

Bed rest recommended for:
- 2 weeks without cardiitis.
- 4 weeks with cardiitis.
- 8 weeks with heart failure or cardiomegaly.
Special diet: Salt and fluid restriction if cardiitis or heart failure is present.
Antibiotics to treat streptococcal infection:
- First choice: Benzylpenicillin.
- Alternative for penicillin allergy: Co-trimoxazole or erythromycin.
Anti-inflammatories for managing inflammation:
- Without carditis: Aspirin; dosing starts high and tapers.
- With severe carditis: Corticosteroids, starting at 2 mg/kg/day, reduced after symptoms subside.
Rationale for corticosteroids over aspirin in carditis: Corticosteroids can prevent serious cardiac complications which aspirin cannot.

Prevention of Recurrence Post-Acute Episode

Prophylaxis with long-acting benzathine penicillin:
- 1,200,000 IU every 3-4 weeks.
Duration of prophylaxis:
- Mild/no carditis: 3 years post-last episode.
- Moderate carditis: Continue until age 21.
- Severe carditis/recurrent RF: Lifelong treatment.

Precautions during Treatment of ARF with Other Conditions

TB: Avoid corticosteroids due to immunosuppression; use alongside antituberculous therapy if necessary.
Congestive heart failure: Implement fluid and salt restrictions; exercise caution with digoxin to prevent arrhythmias.
Diabetes: Adjust insulin if corticosteroids are used, considering possible interactions with antidiabetics.
Peptic ulcers: Administer salicylates carefully to avoid gastric irritation; use enteric-coated preparations and consider H2 blockers or proton pump inhibitors.

Acute Rheumatic Fever (ARF) Definition

Inflammatory disease from untreated or poorly treated Group A β-hemolytic streptococcal infection in the upper respiratory tract.
Caused by antibody cross-reactivity in an autoimmune process.

Incidence

Predominantly affects ages 5-15 years; rare in ages 2-5.
Environmental factors: Poor living conditions and overcrowding contribute.
Genetic predisposition may also play a role.
Incidence and pathogenesis do not differ by sex.

Etiology and Pathogenesis

Follows upper respiratory tract infections with GABHS.
Disease linked to surface antigens (hyaluronic acid, M protein) that resemble host tissues.
Antibodies against these antigens can target connective tissues in the heart, synovial membranes, and skin.
Repeated streptococcal infections sensitize the immune system.

Clinical Manifestations: Jones Criteria

Major Criteria:
- Polyarthritis (70%): Swollen, tender, migratory large joints, resolves without deformity.
- Carditis (50%): Characterized by murmurs, arrhythmias, cardiomegaly, and pericardial rub.
- Rheumatic chorea (10%): Jerky movements and emotional instability, more common in girls.
- Subcutaneous nodules (5%): Painless lumps adjacent to muscles.
- Erythema marginatum (1%): Red patches on limbs and trunk.
Minor Criteria:
- Fever.
- Arthralgia: Joint pain.
- Increased PR interval on ECG.
- Elevated antistreptolysin O titer (ASO).

Diagnosis

At least two major criteria or one major plus two minor criteria required, along with evidence of prior streptococcal infection.
Confirmatory tests: Positive throat culture for GABHS, elevated ASO titers.

Management: Acute Episode

Bed rest recommended for:
- 2 weeks without cardiitis.
- 4 weeks with cardiitis.
- 8 weeks with heart failure or cardiomegaly.
Special diet: Salt and fluid restriction if cardiitis or heart failure is present.
Antibiotics to treat streptococcal infection:
- First choice: Benzylpenicillin.
- Alternative for penicillin allergy: Co-trimoxazole or erythromycin.
Anti-inflammatories for managing inflammation:
- Without carditis: Aspirin; dosing starts high and tapers.
- With severe carditis: Corticosteroids, starting at 2 mg/kg/day, reduced after symptoms subside.
Rationale for corticosteroids over aspirin in carditis: Corticosteroids can prevent serious cardiac complications which aspirin cannot.

Prevention of Recurrence Post-Acute Episode

Prophylaxis with long-acting benzathine penicillin:
- 1,200,000 IU every 3-4 weeks.
Duration of prophylaxis:
- Mild/no carditis: 3 years post-last episode.
- Moderate carditis: Continue until age 21.
- Severe carditis/recurrent RF: Lifelong treatment.

Precautions during Treatment of ARF with Other Conditions

TB: Avoid corticosteroids due to immunosuppression; use alongside antituberculous therapy if necessary.
Congestive heart failure: Implement fluid and salt restrictions; exercise caution with digoxin to prevent arrhythmias.
Diabetes: Adjust insulin if corticosteroids are used, considering possible interactions with antidiabetics.
Peptic ulcers: Administer salicylates carefully to avoid gastric irritation; use enteric-coated preparations and consider H2 blockers or proton pump inhibitors.

Acute Rheumatic Fever (ARF) Definition

Inflammatory disease from untreated or poorly treated Group A β-hemolytic streptococcal infection in the upper respiratory tract.
Caused by antibody cross-reactivity in an autoimmune process.

Incidence

Predominantly affects ages 5-15 years; rare in ages 2-5.
Environmental factors: Poor living conditions and overcrowding contribute.
Genetic predisposition may also play a role.
Incidence and pathogenesis do not differ by sex.

Etiology and Pathogenesis

Follows upper respiratory tract infections with GABHS.
Disease linked to surface antigens (hyaluronic acid, M protein) that resemble host tissues.
Antibodies against these antigens can target connective tissues in the heart, synovial membranes, and skin.
Repeated streptococcal infections sensitize the immune system.

Clinical Manifestations: Jones Criteria

Major Criteria:
- Polyarthritis (70%): Swollen, tender, migratory large joints, resolves without deformity.
- Carditis (50%): Characterized by murmurs, arrhythmias, cardiomegaly, and pericardial rub.
- Rheumatic chorea (10%): Jerky movements and emotional instability, more common in girls.
- Subcutaneous nodules (5%): Painless lumps adjacent to muscles.
- Erythema marginatum (1%): Red patches on limbs and trunk.
Minor Criteria:
- Fever.
- Arthralgia: Joint pain.
- Increased PR interval on ECG.
- Elevated antistreptolysin O titer (ASO).

Diagnosis

At least two major criteria or one major plus two minor criteria required, along with evidence of prior streptococcal infection.
Confirmatory tests: Positive throat culture for GABHS, elevated ASO titers.

Management: Acute Episode

Bed rest recommended for:
- 2 weeks without cardiitis.
- 4 weeks with cardiitis.
- 8 weeks with heart failure or cardiomegaly.
Special diet: Salt and fluid restriction if cardiitis or heart failure is present.
Antibiotics to treat streptococcal infection:
- First choice: Benzylpenicillin.
- Alternative for penicillin allergy: Co-trimoxazole or erythromycin.
Anti-inflammatories for managing inflammation:
- Without carditis: Aspirin; dosing starts high and tapers.
- With severe carditis: Corticosteroids, starting at 2 mg/kg/day, reduced after symptoms subside.
Rationale for corticosteroids over aspirin in carditis: Corticosteroids can prevent serious cardiac complications which aspirin cannot.

Prevention of Recurrence Post-Acute Episode

Prophylaxis with long-acting benzathine penicillin:
- 1,200,000 IU every 3-4 weeks.
Duration of prophylaxis:
- Mild/no carditis: 3 years post-last episode.
- Moderate carditis: Continue until age 21.
- Severe carditis/recurrent RF: Lifelong treatment.

Precautions during Treatment of ARF with Other Conditions

TB: Avoid corticosteroids due to immunosuppression; use alongside antituberculous therapy if necessary.
Congestive heart failure: Implement fluid and salt restrictions; exercise caution with digoxin to prevent arrhythmias.
Diabetes: Adjust insulin if corticosteroids are used, considering possible interactions with antidiabetics.
Peptic ulcers: Administer salicylates carefully to avoid gastric irritation; use enteric-coated preparations and consider H2 blockers or proton pump inhibitors.

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Description

This quiz covers the definition and implications of Acute Rheumatic Fever (ARF) as an inflammatory disease. It explores the complications that arise from untreated streptococcal infections and provides insights into prevention and management.