Rheumatic Fever Overview and Risk Factors

Questions and Answers

What is the most serious complication associated with rheumatic fever?

Joint inflammation

Valvulitis (correct)

Neurological disorders

Skin rashes

Which of the following populations has a higher incidence of rheumatic fever?

East Asians

Caucasians

Native Hawaiians (correct)

Sub-Saharan Africans

What environmental factors significantly contribute to the risk of developing rheumatic fever?

Frequent outdoor activities

Poor personal hygiene (correct)

High levels of physical fitness

Access to healthcare

Which statement accurately reflects the demographics of rheumatic fever?

RF has no gender predilection. Signup and view all the answers

Which of the following is the sole cause of rheumatic fever?

Exposure to group A β-hemolytic streptococci Signup and view all the answers

What is the estimated prevalence of rheumatic heart disease globally?

15–20 million Signup and view all the answers

In which circumstances is rheumatic fever least likely to occur?

In children under 4 years of age Signup and view all the answers

How does genetic predisposition relate to rheumatic fever?

RF is found more frequently in certain families. Signup and view all the answers

What is the first sign that a patient has developed valvular disease?

Heart murmur Signup and view all the answers

Which of the following symptoms is considered a major criterion for rheumatic fever?

Erythema marginatum Signup and view all the answers

What is a common finding during a physical examination for diagnosing rheumatic heart disease?

Thickening of valve cusps Signup and view all the answers

Which option describes a treatment that improves joint symptoms but does not prevent heart injury?

Oral prednisone Signup and view all the answers

What percentage of patients experiencing symptoms of rheumatic fever typically have persistence beyond 6 months?

5% Signup and view all the answers

Which laboratory finding indicates an inflammatory reaction in rheumatic fever?

Elevated C-reactive protein Signup and view all the answers

In patients with rheumatic fever, which of the following is a major manifestation that may be observed?

Chorea Signup and view all the answers

What complication is associated with a poor prognosis in patients who develop cardiomegaly from rheumatic heart disease?

Heart failure Signup and view all the answers

What is commonly found surrounding Aschoff bodies in the cardiac tissue affected by rheumatic fever?

Cells of the immune system Signup and view all the answers

Which valve is most frequently affected by rheumatic fever-related cardiac complications?

Mitral valve Signup and view all the answers

What occurs to the valve leaflets during the acute phase of rheumatic fever?

They become red and swollen. Signup and view all the answers

Which clinical manifestation is NOT typically associated with pharyngitis due to group A streptococcus?

Hoarseness of voice Signup and view all the answers

What is the consequence of fibrosis that occurs after the acute phase of rheumatic fever in heart valves?

Deformity and rigidity of valve leaflets Signup and view all the answers

In which percentage of rheumatic fever patients does tricuspid valve involvement occur alongside mitral or aortic disease?

10% Signup and view all the answers

What is the typical time frame within which symptoms of pharyngitis appear after exposure to the infectious agent?

1-7 days Signup and view all the answers

What laboratory test is most indicative of a group A streptococcus infection in suspected pharyngitis?

Throat culture Signup and view all the answers

What is a potential consequence of untreated rheumatic heart disease (RHD)?

Heart valve deformity Signup and view all the answers

Why is prophylactic antibiotic treatment essential for patients with RHD?

To avoid development of infective endocarditis on damaged valves Signup and view all the answers

What role do anticoagulation efforts play in the management of mitral valve disease?

They prevent blood clots formed from cardiac arrhythmias Signup and view all the answers

What is a common treatment approach for patients with symptomatic RHD?

Surgical repair of damaged heart valves Signup and view all the answers

What is the effect of repeated attacks of rheumatic fever on heart valves?

They cause additive damage leading to RHD Signup and view all the answers

What preventive measure should be taken before dental or surgical procedures for patients with RHD?

Antibiotic prophylaxis Signup and view all the answers

How does rheumatic heart disease affect the heart's structure over time?

It causes gradual thickening of the heart valves Signup and view all the answers

What is considered a critical aspect of managing recurrent rheumatic fever in patients?

Administration of prophylactic antibiotics Signup and view all the answers

What is the primary limitation of newer antigen tests for Group A streptococcal infections?

They may yield false negatives in recent infections. Signup and view all the answers

According to the Jones' criteria, how can rheumatic fever be diagnosed after a streptococcal infection?

By having at least two major symptoms or one major and two minor symptoms. Signup and view all the answers

Which of the following is not considered a major manifestation of rheumatic fever?

Fever Signup and view all the answers

What is the most sensitive test for diagnosing Group A streptococcus?

Serum antistreptolysin O titer (ASO) Signup and view all the answers

What is a key characteristic of Sydenham chorea in rheumatic fever?

Involuntary, spasmodic movements of the tongue and upper extremities. Signup and view all the answers

Which minor criteria can indicate rheumatic fever when present with major manifestations?

Reversible PR interval prolongation Signup and view all the answers

What is the significance of the 1–5 week period following streptococcal infection in rheumatic fever diagnosis?

Symptoms must develop within this period for diagnosis. Signup and view all the answers

Why might a negative antigen test for streptococcal infection require confirmation via throat culture?

Antigen tests have a risk of false negatives. Signup and view all the answers

Study Notes

Rheumatic Fever (RF) Overview

RF is an acute, immune-mediated, multisystem inflammatory disease often following an untreated group A β-hemolytic streptococcal throat infection.
Targets for inflammation include the heart, joints, skin, and central nervous system.
Most serious complication is valvulitis, leading to rheumatic heart disease (RHD).
Rare before age 4 and after age 40; significant health issues in underdeveloped regions due to poverty and poor healthcare.
Approximately 15-20 million people globally have RHD.
Incidence of RF is higher among Native Hawaiians and Maoris; socioeconomic factors may influence disease prevalence, as race does not significantly impact incidence.

Causes and Risk Factors

Only one identifiable cause: exposure to group A β-hemolytic streptococci.
Streptococcal skin infections do not lead to RF.
Environmental factors such as poverty, overcrowding, and poor hygiene increase risk.
Family history suggests a genetic predisposition to RF.

Pathophysiology

RF may exhibit characteristics of an autoimmune disorder.
Antibodies produced against streptococcus can mistakenly target host tissues, leading to damage, particularly in cardiac cells.
Presence of Aschoff bodies, localized lesions associated with RF, contributes to tissue injury.
Mitral valve is involved in up to 60% of cases; damage to heart valves may result in deformities and chronic dysfunction.
Acute RF phase involves valve swelling, which can later lead to scar tissue formation and functional impairment.

Diagnosis

Symptoms of pharyngitis appear 1-5 days post-streptococcal infection: sore throat, fever, and difficulty swallowing.
Physical exam may reveal red pharynx, swollen tonsils, and lymphadenopathy; throat cultures confirm infection.
Diagnosis requires Jones criteria: at least two major manifestations or one major plus two minor criteria post-infection.
Major manifestations include carditis, erythema marginatum, subcutaneous nodules, Sydenham chorea, and arthritis.
Minor signs encompass fever, polyarthralgia, ECG changes, and elevated ESR.
Sydenham chorea is a rare but definitive sign characterized by involuntary movements.

Prognosis and Complications

Approximately 2% recurrence rate for RF; serious symptoms like cardiomegaly and heart failure lead to poorer prognosis.
Symptoms rarely persist beyond six months; identification of valvular disease often follows heart murmur detection.

Treatment and Management

Bed rest is essential until normal temperature and stable ESR rates are achieved.
Salicylates (e.g., aspirin) alleviate fever and joint pain but do not alter disease course.
Oral prednisone may be used for joint symptoms if salicylates are ineffective.
Patients with RHD require prophylactic antibiotics to prevent endocarditis during dental and surgical procedures.
Monitoring for cardiac arrhythmias related to mitral valve disease is crucial to initiate anticoagulation when needed.
Surgical interventions might be necessary for symptomatic RHD patients, emphasizing the importance of preventing recurrent RF episodes with antibiotics.

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Description

Explore the essential aspects of Rheumatic Fever, an acute inflammatory disease often triggered by untreated throat infections. This quiz covers symptoms, complications like rheumatic heart disease, and various risk factors, including environmental and genetic predispositions. Understand the global impact and demographics most affected by this condition.