Rheumatic Fever and Acetone Test Strip Quiz

Impetigo

• Impetigo is a bacterial infection of the skin, most common in young children.
• Causative agents: Grp A Streptococcus, Staphylococcus aureus.
• Incubation period: 7-10 days.
• Period of communicability: From outbreak of lesions until lesions are healed.
• Mode of transmission: Direct contact with lesions.
• Immunity: None.
• Impetigo is most common in children 2 through 5 years old.

Signs and Symptoms of Impetigo

• Red, itchy sores that break open and leak a clear fluid or pus for a few days.
• A crusty yellow or “honeycolored” scab forms over the sore, which then heals without leaving a scar.
• Sores usually take 10 days to appear after exposure to group A strep.

Therapeutic Management of Impetigo

• Localized disease is treated with Mupirocin (Bactroban) ointment for 7 to 10 days or with Retapamulin (Altabax) for children over 9 months twice a day for 5 days.
• Oral antibiotics covering both staphylococcus and streptococcus are reserved for extensive impetigo.

Scabies

• Scabies is an infestation of the skin by the human female itch mite (Sarcoptes scabiei).
• Scabies is found worldwide and affects people of all races and social classes.
• Scabies can spread rapidly under crowded conditions where close body and skin contact is frequent.

Signs and Symptoms of Scabies

• Black burrow filled with mite feces, usually between fingers and toes, on palms, or in axilla or groin.
• Intense itching (pruritus), especially at night, and a pimple-like (papular) itchy rash.
• The rash also can include tiny blisters (vesicles) and scales.
• Scratching the rash can cause skin sores; sometimes these sores become infected by bacteria.

Treatment of Scabies

• Administer scabicides because they kill scabies mites; some also kill eggs.
• Scabicides to treat human scabies are available only with a doctor’s prescription; no “over-the-counter” (non-prescription) products have been tested and approved for humans.

Rheumatic Fever

• Rheumatic fever is an autoimmune disease, a reaction to grp A beta-hemolytic streptococcal infection.
• Inflammation from immune response leads to fibrin deposits, endocardium, and valves, especially mitral valves, as well as in the major body joints.

Assessment of Rheumatic Fever

• Heart involvement: systolic murmur from mitral insufficiency, prolonged P-R and Q-T intervals on ECG, reflecting inflammation and slowing of impulse conduction.
• Sydenham Chorea: sudden involuntary movement of the limbs, loss of involuntary movement, resulting in dysfunctional speech.
• Poor hand control, weak, and spasmodic contractions and relaxation, facial expression changes rapidly from “Cheshire cat” grin to flat, expressionless affect, or grimace.
• Erythema Marginatum: macular rash found predominantly on the trunk, subcutaneous nodules (painless lumps) on tendon sheaths by the joints, tender swollen large joints (polyarthritis) are frequent symptoms.

Laboratory Findings of Rheumatic Fever

• Presence of Antibody anti-streptococcal titer, elevated sedimentation rate, c-reactive protein levels.

Therapeutic Management of Rheumatic Fever

• Maintain bed rest during the acute phase of illness or until congestive heart disease is not present, ESR dec., C-reactive protein level and pulse rate return to normal.
• Penicillin therapy or a single IM injection of Benzathine penicillin to eliminate any grp A beta-hemolytic streptococci in the body.
• Oral ibuprofen or corticosteroid to reduce inflammation and joint pain.
• Phenobarbital and diazepam to reduce purposeless movement of chorea.
• If CHF is present, digoxin and diuretics.