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Rheumatic fever (Clinical
presentation (Malaise, Polyarthritis
(flitting…
Rheumatic fever
Clinical
presentation
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Polyarthritis
(flitting lasts <1w, migrating to other joints)
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Rash
(red raised edges, clear centre)
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Diagnosis
Examination
Cardio
Murmur (diastolic if MS/AR, systolic if MR)
Pericardial rub (if pericarditis)
Musculoskeletal
Tender, erythematous, swollen joints
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Investigations
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Bloods
FBC (high WCC), CRP/ESR (high),
U+E, LFT (baseline)
Rapid strep antigen test (+ve)
Strep Ab titre (high/rising)
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History
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DH
Meds (recent abx), allergies
POH
Scans, bloods, growth, gestation,
delivery, weight, complications
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PC/HPC
Fever, malaise, polyarthritis
Preceeding sore throat (abx?)
SH
Living arrangements,
school/nursery
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Epidemiology
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Rare in developed world, but important
cause of heart disease in children worldwide
Reducing incidence due to imropoved sanitation, living conditions and prompt tx of strep pharyngitis
Pathophysiology
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Mechanism
Abs to strep made during pharyngitic or skin infection
2-6 weeks after infection
Antigens on heart valves similar to those on strep (molecular mimicry) - Abs recognise valves as foreign
Immune destruction of heart valves
Leads to scarring and fibrosis of valves (MS)
Presentation
Carditis, involving endocardium, myocardium and pericardium (effusion, tamponade)
Migratory arthritis affecting multiple joints
Syndenhams chorea
Skin lesions (erythema marginatum, SC nodules) - rare
Management
Medical
Anti-inflammatories
Indication: all patients
E.g. aspirin, ibuprofen
MOA: inhibits inflammation of
heart valves and joints, reduces pain
NB, monitor salicylate levels
Steroids
Indication: anti-inflammatories ineffective
MOA: reduce inflammation of heart valves and joints
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Sedatives
Indication: chorea
E.g. haloperidol, diazepam
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Conservative
Information, advice, support
Self care (bed rest, fluids, limit exercise if ECHO changes)
Complications
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Sydenham chorea
10% of cases
2-6m after infection
Involuntary movements, emotional lability for 3-6m
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