This document discusses rheumatic fever, which is an inflammatory disease that can develop after a streptococcal throat infection. It causes damage to the heart valves and joints. Major symptoms include heart inflammation, migratory arthritis, and abnormal movements. Diagnosis is based on the Jones criteria of symptoms and evidence of prior strep infection. Treatment involves antibiotics to kill the bacteria as well as medications for symptoms. Long-term prevention of recurrence involves ongoing antibiotics.

1. Rheumatic Fever Agnes Therese A. Bravo MD – III

7. Patho genesis group A ß hemolytic strep organism ( pharynx and tonsils ) development of ARF direct infection by the group A streptococcus toxic effect of streptococcal extracellular products on the host tissues abnormal or dysfunctional immune response to one or more

11. Clinical Manifestation

13. Jones Criteria

24. Infective Endocarditis

35. Clinical Manifestations

42. Septic emboli with hemorrhage and infarction due to acute Staphylococcus aureus endocarditis. (Courtesy of L. Baden.)

43. Computed tomography of the abdomen showing large embolic infarcts in the spleen and left kidney of a patient with Bartonella endocarditis.

44. Vegetations ( arrows ) due to viridans streptococcal endocarditis involving the mitral valve.

47. Therapy of Native Valve Endocarditis: Penicillin-Sensitive Streptococci Antibiotic Regimen Duration (wk) Penicillin G 12-18 MU IV every 24 h 4 Ceftriaxone 2 g IV every 24 h 4 Ceftriaxone +Gentamicin 2 g IV every 24 h 1 mg/kg IV every 8 h 2 Vancomycin 1 g IV every 12 h 4 MU=million units; IV=intravenous

48. Therapy of Native Valve Endocarditis for Penicillin-Insensitive Streptococci a or Enterococci b Antibiotic Regimen Duration (wk) Penicillin G + gentamicin 3 MU IV every 4 h 1 mg/kg IV/IM every 8 h 4-6 c 2-6 c Vancomycin + gentamicin d 1 g IV every 12 h 1 mg/kg IV/IM every 8 h 4-6 c 4-6 MU=million units; IV=intravenous; IM=intramuscular Does assume normal renal function. a Minimum inhibitory concentration=0.1-0.5 µg/mL. b Minimum inhibitory concentration >0.5 µg/mL. May want to clarify combo for entire course. c Prolonged therapy for enterococci. d Gentamicin with vancomycin only for enterococci.

52. Therapy of Prosthetic Valve Staphylococcal Endocarditis Isolate Antibiotic Regimen Duration (wk) MSSA or MSSE Oxacillin + gentamicin + rifampin 2 g IV every 4 h 1 mg/kg IV/IM every 8 h 300 mg PO every 8 h > 6 First 2 > 6 MRSA or MRSE Vancomycin + gentamicin + rifampin 1 g IV every 12 h 1 mg/kg IV/IM every 8 h 300 mg PO every 8 h > 6 First 2 > 6 MRSA=methicillin-resistant Staphylococcus aureus ; MRSE=methicillin-resistant Staphylococcus epidermidis ; MSSA=methicillin-sensitive Staphylococcus aureus ; MSSE=methicillin-sensitive Staphylococcus epidermidis ; IV=intravenous; IM=intramuscular; PO=orally. Doses assume normal renal function.

55. Therapy of Endocarditis Due to HACEK Microorganisms Antibiotic Regimen Duration (wk) Ceftriaxone 2 g IV every 24 h 4 Ampicillin + gentamicin 2 g IV every 4 h 1 mg/kg IV/IM every 8 h 4 4 HACEK = Haemophilus, Actinobacillus, Cardiobacterium, Eikenella , and Kingella species of bacteria; IV=intravenous; IM=intramuscular

59. Prevention of Bacterial Endocarditis: Diseases at Risk for Infective Endocarditis High Risk Moderate Risk Negligible Risk Prosthetic heart valves Acquired valvular dysfunction Isolated atrial septal defect Previous bacterial endocarditis Hypertrophic cardiomyopathy Surgical repair of atrial septal defect, ventricular septal defect, or patient ductus arteriosus Complex cyanotic congenital heart disease Mitral valve prolapse with regurgitation Previous coronary artery bypass grafting Surgically constructed pulmonary shunts Mitral valve prolapse without regurgitation Cardiac pacemakers