17 Questions
What is the main component of carditis in cases of acute rheumatic fever?
Valvulitis
In which valve is valvulitis predominantly seen in acute rheumatic fever?
Mitral valve
What percentage of adolescents develop heart defects after the first attack of rheumatic fever?
33%
Which symptom is a manifestation of acute rheumatic fever seen in 10 to 15 percent of cases?
Hyperkinesis
What is a common initial laboratory finding in cases of acute rheumatic fever?
Nonspecific signs of infection
What is a common finding in the complete blood cell count of patients with Acute Rheumatic Fever?
Leukocytosis
Which acute phase reactant is typically elevated in patients with Acute Rheumatic Fever?
C-reactive protein (CRP)
What test can confirm a Group A Streptococcus (GAS) infection?
Positive throat culture
Which disease is NOT part of the differential diagnosis for Acute Rheumatic Fever?
Congenital heart defects
What is the first-line treatment for GAS eradication in Acute Rheumatic Fever patients with a penicillin allergy?
Macrolides
Which medication is considered second-line treatment for symptomatic arthritis and fever in Acute Rheumatic Fever?
Glucocorticoids
What is the major manifestation of acute rheumatic fever affecting the joints?
Arthritis
Which of the following symptoms is NOT associated with Sydenham chorea?
Erythema marginatum rash
What skin manifestation is characteristic of acute rheumatic fever?
Erythema marginatum
What is the significant diagnostic challenge in confirming acute rheumatic fever?
Elevated antistreptococcal titers
Which valve involvement is not commonly seen in rheumatic fever?
Pulmonary valve stenosis
What is the characteristic clinical feature of erythema marginatum?
Central clearing with an outer border
Study Notes
Clinical Features of Rheumatic Fever
- Sydenham chorea: involuntary, irregular, nonrepetitive movements of the limbs, neck, head, and/or face
- Neuropsychiatric symptoms: inappropriate laughing/crying, agitation, anxiety, apathy, obsessive-compulsive behavior
- Skin manifestations: subcutaneous nodules, erythema marginatum (centrifugally expanding pink or light red rash with a well-defined outer border and central clearing)
Cardiac Manifestations
- Mitral valve affected in 25% of cases, leading to mixed mitral stenosis/regurgitation, aortic valve regurgitation, and aortic stenosis (late manifestation)
- Tricuspid valve affected in 10% of cases
- Valvulitis: main component of carditis, mainly affecting the mitral valve, less often the aortic valve
Diagnosis
- Requires 2 large criteria or one large and two small criteria
- Confirmed by previous infection caused by hemolytic streptococcus of group A (2-4 weeks before)
- Laboratory tests: elevated antistreptococcal titer (antistreptolysine-o, antistreptokinase, antistreptochialuronidase), positive pharyngeal swab
Arthritis
- Found in 60-100% of patients
- Characterized by damage to large joints, oligoarthritis, migratory nature, and rapid and complete resolution with treatment
Laboratory Findings
- Complete blood cell count: leukocytosis, normochromic, normocytic anemia of chronic inflammation
- Acute phase reactants: CRP ≥ 30 mg/L, ESR ≥ 60 mm/hour
- Confirmation of GAS infection: elevated or rising antibodies (ASO, ADB), positive throat culture, rapid GAS carbohydrate antigen detection test
Differential Diagnosis
- Lupus (Liebman-Sachs endocarditis)
- Reactive arthritis (poststreptococcal)
- Non-rheumatic myocarditis
- Mitral valve prolapse
- Lyme disease
- Erythema nodosum
Treatment
- GAS eradication: first-line - penicillin V, alternatives - cephalosporins or macrolides
- Symptomatic treatment of arthritis and fever: first-line - NSAIDs, second-line - glucocorticoids (e.g., prednisone)
Test your knowledge on the clinical features associated with rheumatic fever, including Sydenham chorea, neuropsychiatric symptoms, and skin manifestations like subcutaneous nodules and erythema marginatum.
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