14. JONES CRITERIA
MAJOR
MANIFESTATION
MINOR
MANIFESTATION
SUPPORTING
EVIDENCE OF
ANTECENDENT GAS
INFECTION
CARDITIIS CLINICAL FEATURES: POSITIVE THROAT
CULTURE
POLYARTHITIS /
MONOARTHRITIS
ARTHRALGIA (MONO
OR POLY)
OR
FEVER
ERYTHEMA MARGINATUM LAB FINDINGS RAPID STEPTOCOCCAL
ANTIGEN TEST
SUBCUTANEOUS NODULES ESR ELEVATED OR
INCREASING STREP
ANTIBODY TITRE
CRP
CHOREA PROLONGED P-R
INTERVAL
15. my pt is having 2 major criteria present
• SUBCLINICAL CARDITIS
• CHOREA
19. JONES CRITERIA
MAJOR
MANIFESTATION
MINOR
MANIFESTATION
SUPPORTING
EVIDENCE OF
ANTECENDENT GAS
INFECTION
CARDITIIS CLINICAL FEATURES: POSITIVE THROAT
CULTURE
POLYARTHITIS /
MONOARTHRITIS
ARTHRALGIA (MONO
OR POLY)
OR
FEVER
ERYTHEMA MARGINATUM LAB FINDINGS RAPID STEPTOCOCCAL
ANTIGEN TEST
SUBCUTANEOUS NODULES ESR ELEVATED OR
INCREASING STREP
ANTIBODY TITRE
CRP
CHOREA PROLONGED P-R
INTERVAL
20. • INITIAL ATTACK:
• 2 MAJOR MANIFESTATIONS OR 1 MAJOR AND 2
MINOR
• ( PLUS EVIDENCE OF RECENT GAS INFECTION)
21. • RECURRENT ATTACK:
• 2 MAJOR,OR 1 MAJOR AND 2 MINOR OR 3 MINOR
MANIFESTATIONS ( LATTER ONLY IN MODERATE/
HIGH RISK POPULATIONS) PLUS EVIDENCE OF
RECENT GAS INFECTION
22. • CARDITIS IS NOW DEFINED AS CLINICAL AND/OR
SUBCLINICAL (ECHOCARDIOGRAPHIC VALVULITIS)
23. • Arthritis (Major) Polyarthritis In Low
Risk But Also To Monoarthritis Or
Polyarthralgia In Moderate/High Risk
24. • Minor Criteria For Moderate/High Risk
Populations Only Include Monoarthralgia,
(POLYARTHRALGIA FOR LOW RISK
POPULATION)
• Fever Of >38°C, (>38.5 IN LOW RISK)
• Esr > 30 Mm/Hr ( >60 MM/HR IN LOW RISK)
27. • The term chorea is derived from the Greek word for
dancing and was applied initially to epidemics of dancing
mania in the Middle Ages, in which large numbers of
people danced together for days.
29. • SC is a major manifestation of acute rheumatic fever.
• SC typically presents with other manifestations of RF, but
in 20% of cases chorea may be the presenting
or sole manifestation of RF.
30. most common acquired chorea of childhood
•AGE OF ONSET:
• 5 to 15 years of age
•RISK FACTORS:
• Group A beta-hemolytic Streptococcal infection (a
component of Rheumatic Fever)
• F > M
• reported to occur in 20–30% of patients with acute
rheumatic fever (ARF)
31. • Neurochemistry: The main symptoms of SC are believed
to arise from an imbalance among the dopaminergic
system, intrastriatal cholinergic system, and inhibitory
gamma-aminobutyric acid (GABA) system. Evidence of
this imbalance has been suggested by the successful
control of chorea by dopaminergic antagonists and
valproic acid, a drug known to enhance GABA levels in
the striatum and substantia nigra.
32. CLINICAL FEATURES
1Begins abruptly or insidiously about 4 months after infection
•Chorea usually generalized but can be unilateral (20%)
•Affects face, trunk, and distal extremities
•Typical signs:
• Milkmaid's grasp: relaxing & tightening hand shake
• Choreic hand: spooning of flexed hand & extended fingers
• Darting tongue: unable to maintain protruded tongue
• Pronator sign: arms/palms outward when held above head
33. • Usually worsens over several weeks then resolves
spontaneously over months to 1-2 years
34. DIAGNOSIS
• Diagnosis of SC may be difficult, because no single,
established diagnostic test is available.
• SC usually develops in those aged 3-13 years and is
believed to result from a preceding streptococcal
infection. The patient may have no history of rheumatic
fever, and a preceding streptococcal infection cannot
always be documented.
35. • Infections can be subclinical and often precede the
development of neurologic symptoms by age 1-6 months. At
least 25% of patients with SC fail to have serologic evidence of
prior infection.
• Chorea may be the first and only manifestation of
rheumatic fever. However, some patients may have
subtle evidence of carditis by echocardiography
despite a normal clinical examination and ECG.
• Chorea alone is sufficient for diagnosis providing
other causes of the condition have been excluded.
36. TREATMENT:
• SC is usually self-limited, and treatment should be limited
to patients with chorea severe enough to interfere with
function.
• PHENOBARBITAL is the drug of choice
• (16-32 mg every 6 to 8 hourly PO)
• If ineffective then HALOPERIDOL (0.01 – 0.03 mg/kg/24
hr divided BID PO) or CHLORPROMAZINE (0.5mg/kg
every 4 to 6 hr PO )
37. • Prednisone, plasma exchange and intravenous
immunoglobulin (IVIG) have been shown to be effective.
Case reports have suggested IVIG to be a safe, effective
option in disabling SC.
• Because this treatment modality is quite expensive, it
should be reserved for protracted or debilitating cases.
• Children with SC require prophylaxis against
streptococcal infections until 5 yrs or 21 years of age
whichever is latter.
