Rheumatic fever

Between reality & superstition

(A guide to stop over/under-diagnosis)

- : Modified jones Criteria
2 Major + history suggestive of streptococcal infection
Or 1 Major + 2 Minor + history suggestive of strept infection
Or Rheumatic Chorea

Major criteria (5)

Arthritis: :
hot tender , ,
, , limitation of movement
- , , ,

fleeting arthritis
. NSAIDs
septic arthritis collagen disease rheumatic arthritis
Vegaskine 15mg/kg/6h up to 6gm/day therapeutic test of salicylates
6 02 6 10 150mg

 complete relieve of joint 84

" , , , "
Aspirin trade names:
1) Tablets: Aspocid chewable, Ezacard 75mg
Aspico, Jusprin 81mg
Aspocard chewable 150mg
Aspocid, Asponasr, Bufferin, Rivo chewable, Aspocid eff., Ecoprin 320mg
2) Supp: Vegaskine 150mg pediatric supp
Rivo 165mg pediatric supp
3) Injection: Aspegic, Aspirgine 1gm/vial

Carditis:
" layer from heart to be affected "pericarditis, myocarditis, endocarditis

Pericarditis: " "

, retrosternal precordial :
, , ,
PDA ( systolic & diastolic precordial
" area under left clavicle PDA

Myocarditis:
normal heart rate tachycardia out of proportion of fever :
02 1C 02- 42 5
082 032 37.5-38.5 ...
chamber of heart pressure :
accentuated tachycardia muffled heart sounds S1, S2
heart sounds
additional heart congestive heart failure :
gallop rhythm tachycardia sounds S3, S4
mitral valve regurge :
multiple ) Rt subcostal left sternal area apex ( tricuspid, aortic valves
rheumatic fever incompetence murmur

 R P prolonged PR interval minor :

1st degree heart inflammation of myocardium 5
AV node SA node tachycardia tachycardia block

Endocarditis:
mitral stenosis valves edema mitral valve left side
carry comb transient mitral stenosis edema
terminal adhesions between leaflets of mitral valve murmur
mitral stenosis
rupture of valve leaflets chordae tendineae
irreversible valve incompetence

Chorea
until proved otherwise >= Rheumatic Chorea 21
Caudate lobe of basal ganglia

history strept infection 8- 3
ESR ( +ve Acute phase reactants suggestive of recent strept infections
) CRP +ve leukocytosis
sudden jerky semi-purposeful movement

,
.....
dancing gait
--------- signs
forking Piano sign
extension of metacarpophalangeal joint flexion of wrist sign
milking sign

Subcutaneous nodules
not tender freely mobile 3- 0
Tibial tuberosity : extensor surface of bony prominence
)LN ( mastoid process chin of the tibia

Erythema marginatum

3 " "

erythema itchy tinea tinea Circinate
non itchy marginatum
non erythema marginatum scaly Tinea Circinate
scaly
very v very v very rare

Minor Criteria (5)

Positive history of rheumatic fever
myalgia arthralgia arthritis
history of 1st diagnosis pericarditis heart lesion malaise

Fever
3480 - 34

Arthralgia
no hot ,
no limitation of movement tenderness
1 major arthritis 1 criteria
arthralgia 1 minor arthritis

Acute phase reactant +ve

- :
1) ESR elevated
2) CRP +ve
3) Leukocytosis

Prolonged P-R interval in ECG

congestive carditis Criteria
multiple regurge murmur tachycardia out of proportion of fever heart failure

 gallop rhythm congestive heart failure prolonged

PR interval

)History of recent strept infection (3

- :
)0 scarlet fever
strept organism
)0 ASOT 022
)3 throat swap culture +ve for strept

05- 5 ESR ECG PR 5
ASOT 022 sore-throat

05- 5 multiple murmurs over valve + congestive heart failure
" areas "echo CRP
34
ASOT
022
,
,


82
ESR + CRP leukocytosis ASOT ......... 022
major criteria