Acute Rheumatic Fever: Etiology, Diagnosis (Jones Criteria), and Prophylaxis

Acute Rheumatic Fever: Etiology, Diagnosis (Jones Criteria), and Prophylaxis

Question. Describe etiology, diagnostic criteria and prophylaxis of acute rheumatic fever.

Answer.

Etiology

1. Predisposing causes:
   Age should be 5 to 15 years.
   Sex has equal incidence
2. Genetic factors: Family incidence known.
3. Social and economic factors: Dampness, overcrowding and under nutrition increases incidence.
4. Idiosyncrasy is presumably a factor since 3% of people are involved in streptococcal epidemics develop rheumatic fever.

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Clinical Rheumatic Fever

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

Laboratory Rheumatic Fever

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

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Essential criteria 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.

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Confirmation of Diagnosis Rheumatic Fever

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

Management Acute Rheumatic Fever.

1. Treatment of acute attck: Rheumatic Fever

1. Bed rest is important to reduce joint pain and cardiac workload.
   Duration of bed rest is guided by markers of inflmmation like temperature,
   WBC count and ESR.
2. Benzathine penicillin 1.2 mu IM 4 hourly. If patient is allergic to penicillin, erythromycin 40–50 mg / kg for ten days is given.
3. Aspirin usually relieves symptom of arthritis rapidly.
   A starting dose of60 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 produces 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

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2. Secondary prevention: Rheumatic Fever

To prevent further attck of rheumatic fever, long­term prophylaxis is needed.

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