Acute Rheumatic Fever:
see ARF Criteria,
Sydenham Chorea
- non-suppurative, inflammatory disease
- trigger: Group A B-hemolytic strep infection of
upper
resp
tract
- occurs1-5 weeks post pharyngitis/tonsillitis (not
GABHS skin
infxn) vs post-strep
glomerulonephritis can be caused by both skin and resp tract infxn
- risk of permanent damage to heart (valves/muscle)
Incidence: 5-15 y/o; leading cause of heart dz in children
Pathogenesis: cross reactive antibodies to GABHS and human
tissue (joint, heart, brain)Pathology: Aschoff bodies
Dx:
- Evidence of recent GAS infection (Throat culture, ASO, anti Dnase, other
GAS antibodies)
- AND 2 major or 1 major + 2 minor. OR just Chorea
- Name the Major Criteria: ARF Criteria
- Minor Criteria: clinical, lab, ekg and hx: ARF
Criteria
Workup: Get ASLO titer, ESR, CRP, echo. Throat Cx usually not
helpful.TX:
- bed rest
- carditis: 2-4 weeks of steroids
- chorea: chlorpromazine (thorazine) or haldol
-
- salicylates: Treat if confirmed by throat cx or rapid antigen test. Do not tx on clinical
suspicion alone - resistance.
- 10 days of: benzathine
penicillin G (600K to 1200 K U ) or PO penicillin for prevention of
recurrence. Prevents 90% of ARF. Can sub erythro.
- Once a patient is diagnosed with ARF, they need penicillin prophylaxis on
a daily basis to prevent recurrences. This can be in the form of monthly IM
injections, or daily po penicillin The duration depends on the degree of
cardiac involvement, the age of the patient, and the length of time since the
last ARF attack. Pcn for life if have cardiac involvement
- Prophylaxis: Injection q month
- Rheumatic fever without carditis: 5 years
or until 21 yrs of age, whichever is longer
- Rheumatic fever with carditis but without
residual heart disease: 10 years or well into adulthood, whichever is longer
- Rheumatic fever with carditis and residual
heart disease: At least 10 years since last episode and at least until 40
y.o.; sometimes lifelong prophylaxis