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    In the US incidence is 2-14 per 1,000 y infection with Group A Strep occurs 2-4 weeks before sequela Pharyngitis not skin infections y most common in 5-15 yrs y Jones criteria first published in 1944, last revised in Diagnosis y If group a infection proven then need 2 major or 1 major and 2 minor indicate a high probability of ARF y 2 minor manifestations are not diagnostic y a common error is to treat with steroids and ASA before symptoms

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    In the US incidence is 2-14 per 1,000 y infection with Group A Strep occurs 2-4 weeks before sequela Pharyngitis not skin infections y most common in 5-15 yrs y Jones criteria first published in 1944, last revised in Diagnosis y If group a infection proven then need 2 major or 1 major and 2 minor indicate a high probability of ARF y 2 minor manifestations are not diagnostic y a common error is to treat with steroids and ASA before symptoms

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    228 views10 pages

    Rheumatic Fever

    Uploaded by

    shalbern
    In the US incidence is 2-14 per 1,000 y infection with Group A Strep occurs 2-4 weeks before sequela Pharyngitis not skin infections y most common in 5-15 yrs y Jones criteria first published in 1944, last revised in Diagnosis y If group a infection proven then need 2 major or 1 major and 2 minor indicate a high probability of ARF y 2 minor manifestations are not diagnostic y a common error is to treat with steroids and ASA before symptoms

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    of 10

    Rheumatic Fever

    TIFFANY THOMAS, MD PGY3


    6/14/10
    (ONLY 17 MORE DAYS LEFT!)
    Intro

    In the US incidence is 2-14 per 1,000


    Infection with Group A Strep occurs 2-4 weeks
    before sequela
     Pharyngitis not skin infections
     ASO, rapid strep, DNAse B
    Most common in 5-15 yrs
    Jones criteria first published in 1944, last revised in
    1992
    Jones Criteria

    Five Major
     J polyarthritis
     heart carditis
     N subcutaneous nodules
     E erythema marginatum
     S sydenham’s chorea
    Four Minor
     Arthralgia, fever, elevated ESR/CRP, prolonged PR interval
    Diagnosis

    If group A strep infection proven then need 2 major


    or 1 major and 2 minor
     indicate a high probability of ARF
    2 minor manifestations are not diagnostic
    A common error is to treat with steroids and ASA
    before symptoms of ARF are manifest
     no evidence that withholding therapy is harmful
    If chorea present only and all other options excluded
    then you do not have to adhere to strict Jones
    criteria
    Manifestations

    Arthritis- migratory
     Often the earliest symptom
     Mostly in knees, elbows, ankles, wrists (legs first)
     Affected joints overlap in time (each for no more than 1 week)
     Natural course can be altered by use of NSAIDs
    Carditis- pancarditis
     New murmur
     Mitral regurg. most common
     Most devastating complication is heart failure
    Manifestations

    Chorea
     Abrupt, purposeless, nonrhythmic involuntary movements
     Muscular weakness
     Late manifestation
     More marked on one side
     Cease during sleep
    Manifestations
    Subcutaneous nodules
     Early presentation
     Mostly only in pts with
    carditis
     Firm and painless
     Few mm to 1-2 cm
     Over boney surface or over
    tendons
     Present for 1 or more
    weeks (not months)
     Least common (5%)
    Manifestations
    Erythema marginatum
     Occurs early and persists
     Pink or faintly red
     Non-pruritic
     Affects the trunk and
    proximal extremities
     Spares the face
     Hot bath/shower brings
    out
     Disappears /reappears in
    a matter of hours
     Usually only occurs with
    carditis
    Treatment

    Goals: relief of sxms, eradication of GAS, prophylaxis


    against recurrent disease
    Antibiotics
     Eradication of infection: PCN x 10 days
     Prophylaxis: po daily PCN or monthly IM, uncertain duration
    Anti-inflammatory
     High dose ASA until inflamm. markers normalized

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