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Questions and Answers
What is the first typical manifestation of ARF in younger children?
Which joint is least commonly involved in arthritis associated with ARF?
Which of the following is NOT a suspicious sign for carditis in ARF?
What percentage of patients with carditis in ARF develop isolated mitral valve involvement?
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What criterion is NOT part of the Jones criteria for diagnosing initial ARF?
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Which of the following is NOT considered a major manifestation of acute rheumatic fever?
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What is a major criterion that can be detected by echocardiography?
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What was the estimated incidence of infective endocarditis in 2019?
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Which laboratory finding is indicative of a preceding group A streptococcal infection?
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What is a key clinical feature that should prompt consideration of infective endocarditis?
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In moderate- and high-risk populations, which is considered a minor manifestation?
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Which of the following conditions may mimic the symptoms of infective endocarditis?
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Which antibiotic is the drug of choice for treating acute rheumatic fever in non-allergic individuals?
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What is the designation of the pattern observed in post-infectious glomerulonephritis?
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What abnormal finding may a chest radiograph reveal in a patient with acute rheumatic fever?
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What is the time frame between streptococcal pharyngitis and the onset of acute rheumatic fever?
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Which of the following antistreptococcal antibodies is NOT typically used for diagnosing true infection?
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Which demographic is most commonly affected by acute rheumatic fever?
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Which acute phase reaction is included as a minor manifestation in low-risk populations?
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What concerns health professionals about oral streptococci in recent years?
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What percentage of young children typically recollect having pharyngitis associated with acute rheumatic fever?
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Study Notes
Infective Endocarditis
- Estimated incidence of 13.8 cases per 100,000 subjects per year in 2019
- 66,300 deaths worldwide in 2019
- Diagnostic challenge due to variable clinical presentation
- Consider diagnosis in patients with sepsis, fever of unknown origin, or risk factors
- Can manifest as acute, subacute, or chronic infection
- May present with non-specific symptoms that mimic other conditions
Risk Factors
- Not defined in text
Acute Rheumatic Fever (ARF)
- Develops 2-3 weeks after group A streptococcal pharyngitis
- Most common in children, with rheumatic, cardiac, and neurological manifestations
- Incidence has declined in developed countries
History of ARF
- Latent period of ~18 days between pharyngitis and ARF onset
- Pharyngitis is recalled by 70% of older children/adults, but only 20% of young children
- First manifestation is usually painful migratory polyarthritis, affecting large joints
- Sydenham chorea is a rare late-onset manifestation
Physical Examination
- Physical findings can be nonspecific
- Suspicious signs of carditis include new/changing murmurs, cardiomegaly, heart failure, and pericarditis
- Nearly 60% of patients with carditis develop isolated mitral valve involvement
Arthritis
- Occurs in 80% of patients
- Involves multiple large joints, particularly knees, ankles, elbows, and wrists
- Migratory polyarthritis is usually associated with fever
Diagnostic Considerations
- Bacterial endocarditis
- Still disease (Systemic-onset juvenile rheumatoid arthritis or adult Still disease)
- Vasculitis
Jones Criteria for ARF Diagnosis
- Two major manifestations OR one major and two minor manifestations
-
Major Manifestations:
- Carditis (clinical or subclinical)
- Arthritis
- Chorea
- Erythema marginatum
- Subcutaneous nodules
Minor Manifestations
-
Low-risk populations:
- Polyarthralgia
- Fever ≥ 38.5°C
- Acute phase reactions (ESR ≥ 60 mm/hour or CRP ≥ 3.0 mg/dL)
- Prolonged PR interval (unless carditis is a major criterion)
-
Moderate- and high-risk populations:
- Monoarthralgia
- Fever ≥ 38°C
- ESR ≥ 30 mm/h or CRP ≥ 3.0 mg/dL
- Prolonged PR interval (unless carditis is a major criterion)
Laboratory Studies
- Elevated or rising streptococcal antibody titer
- Positive throat culture for group A β-hemolytic streptococci
- Positive rapid group A streptococcal carbohydrate antigen test
- Antistreptolysin O (ASO)
- Antideoxyribonuclease B (anti-DNAse B)
- Antistreptokinase
- Antihyaluronidase
- Anti-DNAase (anti-DNPase)
Chest Radiography
- May reveal cardiomegaly
Echocardiography
- Gold standard for diagnosis of rheumatic heart disease
Medical Care
- Management of the acute attack: eradicate streptococcal organisms
- Management of the current infection
- Prevention of further infection and attacks
Surgical Care
- Not discussed
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Description
Explore the complexities of Infective Endocarditis and Acute Rheumatic Fever, including their incidence, clinical presentations, and risk factors. Understand the diagnostic challenges and manifesting symptoms, alongside the historical context of ARF post-streptococcal infections.
