Rheumatic fever

1. RHEUMATIC FEVER
PROF. M. S. ABDULLAH
AGA KHAN HOSPITAL
AUGUST 2018

2. RHEUMATIC FEVER

3. RHEUMATIC FEVER

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11. RHEUMATIC FEVER
Major criteria
Polyarthritis:[32] A temporary migrating inflammation of the large joints, usually
starting in the legs and migrating upwards.
Carditis: Inflammation of the heart muscle (myocarditis) which can manifest
as congestive heart failure with shortness of breath, pericarditis with a rub, or
a new heart murmur.
Subcutaneous nodules: Painless, firm collections of collagen fibers over bones
or tendons. They commonly appear on the back of the wrist, the outside
elbow, and the front of the knees.
Erythema marginatum: A long-lasting reddish rash that begins on the trunk or
arms as macules, which spread outward and clear in the middle to form rings,
which continue to spread and coalesce with other rings, ultimately taking on a
snake-like appearance. This rash typically spares the face and is made worse
with heat.
Sydenham's chorea (St. Vitus' dance): A characteristic series of involuntary
rapid movements of the face and arms. This can occur very late in the disease
for at least three months from onset of infection.

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Minor criteria
Fever of 38.2–38.9 °C (100.8–102.0 °F)
Arthralgia: Joint pain without swelling (Cannot be
included if polyarthritis is present as a major symptom)
Raised erythrocyte sedimentation rate or C reactive
protein
Leukocytosis
ECG showing features of heart block, such as a
prolonged PR interval[31][33] (Cannot be included if carditis
is present as a major symptom)
Previous episode of rheumatic fever or inactive heart
disease

13. RHEUMATIC FEVER
Treatment
Antibiotics: Penicillin benzathine benzylpenicillin.
Monthly injections of long-acting penicillin must be
given for a period of five years in patients having one
attack of rheumatic fever.
If there is evidence of on going carditis, the length of
therapy may be up to 40 years.
Another important cornerstone in treating rheumatic
fever includes the continual use of low-dose oral
antibiotics (such as penicillin, sulfadiazine,
or erythromycin) to prevent recurrence

14. RHEUMATIC FEVER
Steroids are reserved for cases where there is
evidence of lige threatening involvement of the heart.
The use of steroids may prevent further scarring of
tissue and may prevent the development of sequelae
such as mitral stenosis.