Podcast
Questions and Answers
Patients weighing 27 kg or less should receive 600,000 units of Benzathine Penicillin G IM every month.
Patients weighing 27 kg or less should receive 600,000 units of Benzathine Penicillin G IM every month.
True (A)
The maximum dose of Azithromycin for patients allergic to penicillin is 500 mg per day.
The maximum dose of Azithromycin for patients allergic to penicillin is 500 mg per day.
False (B)
Antibiotic prevention after rheumatic fever without carditis lasts for 5 years from the last rheumatic attack.
Antibiotic prevention after rheumatic fever without carditis lasts for 5 years from the last rheumatic attack.
True (A)
A patient weighing 28 kg should receive 1 g of Sulfadiazine orally once daily.
A patient weighing 28 kg should receive 1 g of Sulfadiazine orally once daily.
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Rheumatic fever is primarily caused by a viral infection.
Rheumatic fever is primarily caused by a viral infection.
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Symptoms of acute rheumatic fever can develop within two to three weeks after a streptococcal infection.
Symptoms of acute rheumatic fever can develop within two to three weeks after a streptococcal infection.
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Rheumatic fever occurs more frequently in adults than in children.
Rheumatic fever occurs more frequently in adults than in children.
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The presence of 2 major criteria is required for diagnosing an initial episode of acute rheumatic fever.
The presence of 2 major criteria is required for diagnosing an initial episode of acute rheumatic fever.
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Chorea is characterized by smooth, controlled movements of the body.
Chorea is characterized by smooth, controlled movements of the body.
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Rheumatic heart disease can develop if acute rheumatic fever is untreated.
Rheumatic heart disease can develop if acute rheumatic fever is untreated.
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Subcutaneous nodules are considered a major criterion for diagnosing rheumatic fever.
Subcutaneous nodules are considered a major criterion for diagnosing rheumatic fever.
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Symptoms of acute rheumatic fever usually appear 2 to 3 weeks after infection.
Symptoms of acute rheumatic fever usually appear 2 to 3 weeks after infection.
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Aspirin is the first-line anti-inflammatory analgesic for rheumatic arthritis.
Aspirin is the first-line anti-inflammatory analgesic for rheumatic arthritis.
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Prednisolone is used to treat carditis with heart failure.
Prednisolone is used to treat carditis with heart failure.
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Proton pump inhibitors are not recommended for patients requiring prolonged anti-inflammatory treatment.
Proton pump inhibitors are not recommended for patients requiring prolonged anti-inflammatory treatment.
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Rivaroxaban is an anti-inflammatory drug used for treating arthritis.
Rivaroxaban is an anti-inflammatory drug used for treating arthritis.
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Subcutaneous nodules associated with rheumatic fever are generally self-limited.
Subcutaneous nodules associated with rheumatic fever are generally self-limited.
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Sydenham chorea is not self-limited and requires constant medication.
Sydenham chorea is not self-limited and requires constant medication.
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Patients weighing 27 kg or less should receive 250 mg of Penicillin V three times daily for 10 days.
Patients weighing 27 kg or less should receive 250 mg of Penicillin V three times daily for 10 days.
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Beta-blockers are used to manage arrhythmias in patients with carditis.
Beta-blockers are used to manage arrhythmias in patients with carditis.
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Haloperidol and Carbamazepine are considered ineffective for refractory cases of Sydenham chorea.
Haloperidol and Carbamazepine are considered ineffective for refractory cases of Sydenham chorea.
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Study Notes
Rheumatic Fever Overview
- Acute rheumatic fever (ARF) is a complication of group A streptococcal pharyngeal infections.
- Symptoms develop two to three weeks after the infection and can include arthritis, carditis, chorea, subcutaneous nodules, and erythema marginatum.
- Risk factors include age (most common in school-age children 5-15 years old), genetics, and environmental factors like overcrowding and poor sanitation.
- Rheumatic fever is caused by group A beta-hemolytic streptococci, often from untreated strep throat.
- Group A strep infections of the skin or other body parts can rarely cause rheumatic fever.
- Molecular mimicry is the pathogenic mechanism; autoantibodies and T cells target group A strep cell wall (M protein) and mimic bacterial material in healthy tissues.
Presentation
- History of streptococcal pharyngitis or skin infections two to four weeks before ARF onset is typical.
- Symptoms include: arthritis (wrist, knee, elbow, ankle pain), chorea (jerky movements), fatigue, fever, subcutaneous nodules, and rash (erythema marginatum).
- Complications include rheumatic heart disease (possible weakening of valves and associated complications like chest pain, tachycardia, dyspnea, murmurs).
Diagnosis
- Diagnosis is based on the Modified Jones Criteria.
- Requires presence of two major criteria or one major and two minor criteria for initial ARF diagnosis.
- Recurrent episodes require different criteria, potentially including three minor criteria.
Major Criteria
- Rheumatic arthritis
- Rheumatic carditis (inflammation of the heart)
- Rheumatic chorea (jerky movements)
- Subcutaneous nodules
- Erythema marginatum (rash)
Minor Criteria
- Polyarthritis (joint pain)
- Fever ≥ 38.5°C
- Elevated erythrocyte sedimentation rate (ESR) > 60 mm/h and/or C-reactive protein (CRP) > 3.0 mg/dL
- Prolonged PR interval on electrocardiogram (ECG)
- Positive laboratory tests for recent streptococcal infection (ASO, anti-DNase B titers)
Treatment Acute Rheumatic Fever
- Treatment goals: relieve symptoms, eradicate streptococcal infection, prevent future recurrences, and mitigate cardiac damage.
- Hospitalization is often necessary to confirm diagnosis and facilitate echocardiogram.
- Symptoms like arthritis: First-line treatment usually includes non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen or naproxen.
- Carditis: Treatment includes anti-inflammatory drugs like prednisolone along with other measures like IVIG, beta-blockers, or amiodarone depending on the severity.
- Heart failure: Add ACE inhibitors (e.g., captopril) and diuretics.
- Sydenham chorea: May resolve spontaneously or require medications like corticosteroids or antipsychotics.
Eradication of Streptococci
- Treatment for streptococcal infection typically involves antibiotics like amoxicillin, penicillin V, or procaine penicillin G, depending on patient weight and health.
Prevention of Rheumatic Fever
- Reducing the spread of group A strep is crucial.
- Early diagnosis and appropriate treatment of streptococcal infections are critical in preventing the initial attack of ARF.
- Preventing recurrent attacks focuses on preventing further streptococcal infections.
- Duration of antibiotic prophylaxis varies greatly depending on whether there was carditis, valvular involvement, etc.
Prevention against Bacterial Endocarditis
- Patients at risk (e.g., rheumatic heart disease) require prophylactic antibiotics before dental procedures or invasive respiratory surgeries.
- Antibiotics like amoxicillin, cephalexin, ampicillin, or ceftriaxone, or doxycycline or azithromycin are used based on allergic status.
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Description
This quiz covers the essential details about acute rheumatic fever, its symptoms, risk factors, and the underlying causes. Explore concepts such as molecular mimicry and the association with group A streptococcal infections. Ideal for understanding this significant health issue, especially in children.
