Rheumatic Fever Overview

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Questions and Answers

Which of the following clinical manifestations is NOT a result of rheumatic fever carditis?

Dull aching chest pain

Tachycardia out of proportion to age

Stitching chest pain (correct)

Muffled heart sounds

Which of the following is a characteristic feature of Sydenham Chorea?

Fever with joint pain

Irregular contractions of limbs (correct)

Dullness outside the apex

Dry pericarditis

Which valve is most commonly affected by endocarditis associated with rheumatic fever?

Mitral valve (correct)

Pulmonary valve

Coronary valve

Tricuspid valve

In which scenario would it be inappropriate to use arthralgia as a minor manifestation of rheumatic fever?

Patient has active arthritis Signup and view all the answers

What is a common manifestation of myocarditis that indicates severe carditis?

Gallop rhythm Signup and view all the answers

What is a common feature of erythema marginatum in rheumatic fever?

Firm, mobile, painless, pea-sized nodules Signup and view all the answers

Which of the following statements about pericarditis associated with rheumatic fever is correct?

Dullness outside the apex indicates pericardial effusion. Signup and view all the answers

What percentage of rheumatic fever cases typically manifests with carditis?

40-50% Signup and view all the answers

Which condition is most commonly associated with acute congestive heart failure?

Myocarditis Signup and view all the answers

What are the clinical signs indicative of cardiomegaly?

Precordial bulge and epigastric pulsations Signup and view all the answers

Which of the following complications is NOT associated with organic valve lesions?

Chronic fatigue Signup and view all the answers

Which symptom is characteristic of pulmonary hypertension due to long-standing mitral valve lesions?

dyspnea and fatigue Signup and view all the answers

What factors suggest the presence of rheumatic activity during a fever episode?

Change in character of existing murmur Signup and view all the answers

What does a prolonged P-R interval indicate in the context of rheumatic fever diagnosis?

It cannot be used as a minor manifestation if carditis is present. Signup and view all the answers

How many major criteria are needed to indicate a high probability of acute rheumatic fever?

Two major criteria. Signup and view all the answers

Which of the following acts as supporting evidence of streptococcal infection?

Increased Titer of Anti-Streptococcal Antibodies ASO. Signup and view all the answers

Which of the following exceptions to the Jones criteria can diagnose acute rheumatic fever alone?

Rheumatic chorea. Signup and view all the answers

What is considered evidence of recent streptococcal infection?

Positive throat culture for Group A Streptococcus. Signup and view all the answers

In patients with documented chronic rheumatic heart disease, what can lead to a diagnosis of rheumatic activity?

Minor criteria plus evidence of recent strept infection. Signup and view all the answers

Which of the following is NOT a major manifestation of rheumatic fever?

Leukocytosis. Signup and view all the answers

What role does the presence of elevated acute phase reactants play in the diagnosis of rheumatic fever?

It provides laboratory evidence but does not impact the major criterion count. Signup and view all the answers

What is the primary method for diagnosing rheumatic fever?

Modified Jones criteria Signup and view all the answers

What should be the duration of secondary prevention with long-acting penicillin for a patient with carditis and residuals?

For life or till age of 40 Signup and view all the answers

Which of the following treatments is recommended for typical migratory polyarthritis in rheumatic fever?

Oral salicylates Signup and view all the answers

What is the recommended dose of Benzathine penicillin G for patients weighing more than 27 kg?

1,200,000 units Signup and view all the answers

Which type of penicillin should be used for children with streptococcal pharyngitis if they are allergic to penicillin?

Erythromycin Signup and view all the answers

What is the recommended duration of treatment with Penicillin V for streptococcal pharyngitis in adults?

10 days Signup and view all the answers

In which stage of treatment for rheumatic fever is the focus on the eradication of streptococci?

Step I - primary prevention Signup and view all the answers

Which sign is primarily associated with rheumatic fever and can serve as a diagnostic clue?

Prolonged PR interval Signup and view all the answers

What is the initial daily dosage of aspirin for a patient based on their weight?

50-70 mg/kg/day Signup and view all the answers

When should serum salicylate levels be determined?

Only if there are signs of toxicity Signup and view all the answers

What is the recommended prednisone dose for patients with carditis?

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

What is the duration of secondary prophylaxis for rheumatic fever with carditis and residual heart disease?

At least 10 years or until age 40 Signup and view all the answers

Which medication is advised for preventing rebound inflammation while tapering prednisone?

Aspirin Signup and view all the answers

What is the dosage of benzathine penicillin G recommended for secondary prevention?

1,200,000 U every 3 weeks Signup and view all the answers

Which of the following treatments is specifically recommended for chorea?

Phenobarbitone or haloperidol Signup and view all the answers

What is the maximum duration for secondary prophylaxis in someone with rheumatic fever without carditis?

Until age 21 Signup and view all the answers

What is a recommended treatment for congestive cardiac failure in rheumatic fever patients?

Diuretics and vasodilators Signup and view all the answers

Study Notes

Rheumatic Fever

Rheumatic fever is an inflammatory disease that can affect the heart, joints, brain, and skin.
It is caused by a bacterial infection with group A Streptococcus (GABHS).
The bacteria can trigger an autoimmune response, where the body's immune system attacks its own tissues.

Clinical Features

Rheumatic fever usually develops 2-3 weeks after a streptococcal infection like strep throat or scarlet fever.
Major criteria:
- Carditis: inflammation of the heart (40-50% of cases)
- Polyarthritis: inflammation of multiple joints
- Chorea: involuntary movements, more common in girls (8-12 years old)
- Erythema Marginatum: a rash that looks like a red ring
- Subcutaneous Nodules: small, painless lumps under the skin
Minor Criteria:
- Fever (38.4- 40 °C)
- Arthralgia (joint pain)
- Prolonged P-R interval on ECG
- Elevated acute phase reactants (ESR, C-reactive protein, leukocytosis)
- Anti-DNAse B test
Jones Criteria: diagnosis requires 2 major criteria, OR 1 major and 2 minor criteria, supported by evidence of a recent strep infection.

Treatment

Primary Prevention (eradication of streptococci):
- Treatment of streptococcal pharyngitis with penicillin or erythromycin for 10 days.
Secondary Prevention (prevention of recurrence):
- Long-acting penicillin (Benzathine penicillin) - given every 3-4 weeks for a minimum of 5 years after the last episode for individuals without carditis.
- For those with carditis, long-term prophylaxis is recommended for at least 10 years or until the age of 40 for cases with residual valve damage.
Step II: Anti-inflammatory Treatment:
- Oral salicylates (aspirin) for typical migratory polyarthritis and carditis without cardiomegaly or congestive heart failure.
- Corticosteroids (prednisone) for carditis with cardiomegaly and/or congestive heart failure.
Step III: Supportive Management & Management of Complications:
- Bed rest
- Treatment of congestive cardiac failure (diuretics, vasodilators, digoxin cautiously)
- Treatment of chorea (phenobarbital or haloperidol)
- Rest to joints and supportive splinting

Diagnosis

Rheumatic fever diagnosis is primarily clinical.
No single diagnostic test exists.

Complications

Congestive Heart Failure:
- Acute: due to myocarditis
- Chronic: episodes of acute failure precipitated by rheumatic activity, infective endocarditis, chest infections
Cardiomegaly: heart enlargement due to carditis, heart failure, or multivalvular lesions.
Chronic Valve Lesions: permanent damage to heart valves due to carditis, especially in recurrences.
**Rheumatic Activity (Recurrences): **
- Suggested by fever, arthritis/arthralgia, changes in heart murmurs.
- Can diagnose rheumatic fever attacks in the presence of recent streptococcal infections.
Pulmonary Hypertension:
- Due to long-standing mitral valve lesions.

Prognosis

Rheumatic fever can recur with new GABHS infections, especially if not on prophylactic medication.
Good prognosis for older age groups and those without carditis during the initial attack.
Bad prognosis for younger children and those with carditis with valvular lesions.

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Description

This quiz covers the key features and clinical aspects of rheumatic fever, an inflammatory disease linked to streptococcal infections. It includes information on major and minor criteria as well as associated symptoms and complications. Test your understanding of this complex condition and its impact on the body.