Acute Rheumatic Fever Diagnosis And Management

Acute Rheumatic Fever Diagnosis And Management

Question. How will you diagnose and manage a case of rheumatic fever? Outline the complications of rheumatic fever.

Answer.

Diagnosis of rheumatic fever is made by the ‘Jones criteria’, which is as follows:

Major criteria for Rheumatic Fever

1. Carditis: Rheumatic Fever

1. It is pancarditis involving the endocardium, myocardium, and pericardium.
2. It manifests as breathlessness, palpitation, and chest pain.
3. Tachycardia, cardiomegaly, and new or changed murmurs
4. Aortic regurgitation in 50% of cases.
5. Pericarditis produces frictional rub and pericardial tenderness.
6. Cardiac failure due to myocardial infarction.

Acute Rheumatic Fever Diagnosis and Management

2. Sydenham’s chorea: Rheumatic Fever

1. Late neurological manifestations that occurs at least three months after the episode of acute rheumatic fever when all signs disappear.
2. More common in females.
3. It is characterized by involuntary dancing movements of hands, feet or face.

3. Polyarthritis: Rheumatic Fever

1. The early feature of illness is non-specific.
2. It is characterized by acute, painful, symmetric, and migratory inflammation of large joints.
3. Classical presentation is acute migratory polyarthritis.
   Pain and swelling in the involved joints subside or disappear as newer joints get affected.

4. Erythema marginatum: Rheumatic Fever

Red macules which fade in the centre, but remain red at the edges, and occur mainly on the trunk and proximal extremities on the face.

Diagnosis of Acute Rheumatic Fever and Treatment

5. Subcutaneous nodules: Rheumatic Fever

They are small, dense, firm, painless, and are best felt over tendons and bones.

Nodules appear more than 3 weeks after the onset of other manifestations.

Clinical Rheumatic Fever

1. Fever
2. Arthralgia
3. Previous history of rheumatic fever or rheumatic heart disease.

Laboratory Rheumatic Fever

1. Acute phase reactants (leucocytosis, raised ESR, C­ C-reactive protein)
2. Prolonged PR interval in ECG.

Essential criteria for Rheumatic Fever

Evidence for recent streptococcal infection as evidenced by:

1. Increase in ASO titer

1. > 333 Todd units (in children).
2. > 250 Todd units (in adults).
3. Positive throat culture for streptococcal infection
4. Recent history of scarlet fever.

Confirmation of Diagnosis: Rheumatic Fever

The result is based on the Presence of two or more major criteria or one major and two minor criteria; in the presence of essential criteria, is required to diagnose acute rheumatic fever.

Management of Rheumatic Fever

1. Treatment of acute attack:

1. Bed rest is important to reduce joint pain and cardiac workload.
   Duration of bed rest is guided by markers of inflammation like temperature,
   WBC count and ESR.
2. Benzathine penicillin 1.2 mu IM 4 hourly. If the patient is allergic to penicillin, erythromycin 40–50 mg/kg for ten days is given.
3. Aspirin usually relieves symptoms of arthritis rapidly.
   A starting dose of 60 mg/kg body weight per day is given, divided into 6 doses.
   The dose may be increased to 120 mg/kg body weight.
   This dose may produce severe symptoms like vomiting, tachypnea, and acidosis. Aspirin is given till ESR comes to normal.
4. Corticosteroids like prednisolone produce rapid symptomatic relief than aspirin and is indicated in cases with severe arthritis or carditis.
   Prednisolone is given in doses of 1.2 mg/kg body weight till ESR comes to normal

2. Secondary prevention: Long-term prophylaxis is needed to prevent further attacks of rheumatic fever.

1. Benzathine penicillin 1.2 mu IM is injected at an interval of 21 days.
   Further attacks is unusual after the age of 21 years, and treatment can be stopped.
2. To prevent the chances of endocarditis, prophylactic antibiotic therapy should be given.

Complications Of Rheumatic Fever

1. Myocardial infarction
2. Mitral stenosis
3. Tricuspid regurgitation
4. Aortic regurgitation
5. Aortic stenosis is rare
6. Mitral regurgitation.