. Description
Inflammatory disease affecting skin, joints, heart, subcutaneous tissue, and central nervous system that develops following group A streptococcal pharyngitis. Common cause of valvular heart disease, but incidence declining in developed countries. Valvular sequelae include stenosis and/or regurgitation of aortic and/or mitral valves, less commonly affects right-sided heart valves.
. Symptoms
Fever, malaise, polyarthritis, chorea, rash. Dyspnea from acute heart failure caused by valvular regurgitation and for myocarditis. Acute pericarditis can occur. Many cases resolve without clinical sequelae. Most common in children 5 to 15 years of age, although can occur in any age group.
. Diagnosis
History, exam. Many of the signs, symptoms, and laboratory findings of acute rheumatic fever (ARF) are non-specific, so the modified Jones criteria are often required for diagnosis: two major criteria, or one major and two minor criteria, and evidence (usually serologic) of preceding streptococcal infection.
A. Major Criteria
Carditis-most common and most reliable signB. Minor Criteria
Fever. Pathology
Invasive infection with group A Streptococcus probably elicits an antibody response with cross-reactivity with host tissues (autoimmune mechanism).
. Treatment
Penicillin (but does not prevent subsequent heart disease), bed rest, salicylates Corticosteroids if evidence of moderate or severe carditis. Diuretics, salt restriction if CHF develops. Sedatives for chorea. Cardiac surgery rarely required for severe valvular regurgitation during acute phase of illness.
. Prevention
Prevention of initial attack of ARF by adequate and prompt antibiotic therapy for streptococcal pharyngitis. Prevention of recurrent attack of ARF by long-term prophylaxis against recurrent group A streptococcal infection.
Back to Previous Week's Questions