Acute rheumatic fever: Difference between revisions
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==Background== | |||
*Primarily affects school age children 2-6wk after strep pharyngitis | |||
*Connective tissue of heart, joints, CNS, subq tissues are targeted by immune reaction | |||
==Diagnosis== | ==Diagnosis== | ||
Modified Jones Criteria (1992) for Acute Rheumatic Fever | Modified Jones Criteria (1992) for Acute Rheumatic Fever | ||
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#Major diagnostic criteria | #Major diagnostic criteria | ||
##Carditis | ##Carditis | ||
## | ###New or changing murmur, cardiomegaly, CHF, pericarditis | ||
##Migratory polyarthritis | |||
##Chorea | ##Chorea | ||
##Subcutaneous nodules | ##Subcutaneous nodules | ||
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##Fever | ##Fever | ||
##Arthralgia | ##Arthralgia | ||
##Prolonged PR interval | ##History of previous attack of rheumatic fever | ||
##Elevated | ##Prolonged PR interval | ||
##Elevated ESR, CRP | |||
##Positive throat | #Evidence of preceding streptococcal infection | ||
##Increased ASO or other strep ab | |||
##Positive throat culture for Group A strep | |||
##Positive rapid GAS | |||
##Recent scarlet fever | |||
==Symptoms== | ==Symptoms== | ||
*Polyarthritis | |||
**Most common symptom (75%) | |||
**Migratory, fleeting polyarticular arthritis primarily affecting large joints | |||
*Carditis (33%) | |||
* | **Most serious complication and second most common | ||
***New murmur, pericardial rub, CHF | |||
*Chorea (10%) | |||
**May appear months following strep infection, may be sole manifestation of RF | |||
*Erythema marginatum | |||
**Persists only for several days | |||
**Usually coexists with presence of carditis in some form | |||
**Nonpruritic, located on trunk and proximal limbs, never on face | |||
*Nodules | |||
**Located on extensor surfaces of wrists, elbows, knees | |||
== | ==DDX== | ||
# | #JIA | ||
## | #septic arthritis | ||
# | #Kawasaki disease | ||
# | #viral or other forms of cardiomyopathy | ||
# | #leukemia | ||
#vasculitis (HSP, drug reaction) | |||
== | ==Work-Up== | ||
#CBC | |||
#ECG | |||
#CXR | |||
#ESR, CRP | |||
==Treatment== | |||
*Penicillin | |||
**Indicated for all pts w/ rheumatic fever even if cx for strep is negative | |||
**600K units IM if <27 kg | |||
**1.2 million units IM if >27 kg | |||
**Penicillin V PO x10d | |||
**Prophylaxis | |||
***5yr if no cardiac involvement, lifetime if cardiac involvement | |||
***Pen G IM q month or oral penicillin daily | |||
**Erythromycin x10d if pen allergic | |||
*Arthritis | |||
**High-dose aspirin therapy (75-100 mg/kg/d) | |||
*Carditis | |||
**Prednisone 1-2mg/kg/d | |||
*Chorea | |||
**Haloperidol 0.01-0.03 mg/kg/d in four divided doses | |||
==Disposition== | |||
*Admit for confirmation of diagnosis | |||
==Source == | |||
Tintinalli | |||
[[Category:Peds]] | |||
[[Category:ID]] | [[Category:ID]] |
Revision as of 19:58, 27 June 2011
Background
- Primarily affects school age children 2-6wk after strep pharyngitis
- Connective tissue of heart, joints, CNS, subq tissues are targeted by immune reaction
Diagnosis
Modified Jones Criteria (1992) for Acute Rheumatic Fever
REQUIRE: 2 major or 1 major and 2 minor criteria and evidence of previous GAS pharyngitis.
- Major diagnostic criteria
- Carditis
- New or changing murmur, cardiomegaly, CHF, pericarditis
- Migratory polyarthritis
- Chorea
- Subcutaneous nodules
- Erythema marginatum
- Carditis
- Minor diagnostic criteria
- Fever
- Arthralgia
- History of previous attack of rheumatic fever
- Prolonged PR interval
- Elevated ESR, CRP
- Evidence of preceding streptococcal infection
- Increased ASO or other strep ab
- Positive throat culture for Group A strep
- Positive rapid GAS
- Recent scarlet fever
Symptoms
- Polyarthritis
- Most common symptom (75%)
- Migratory, fleeting polyarticular arthritis primarily affecting large joints
- Carditis (33%)
- Most serious complication and second most common
- New murmur, pericardial rub, CHF
- Most serious complication and second most common
- Chorea (10%)
- May appear months following strep infection, may be sole manifestation of RF
- Erythema marginatum
- Persists only for several days
- Usually coexists with presence of carditis in some form
- Nonpruritic, located on trunk and proximal limbs, never on face
- Nodules
- Located on extensor surfaces of wrists, elbows, knees
DDX
- JIA
- septic arthritis
- Kawasaki disease
- viral or other forms of cardiomyopathy
- leukemia
- vasculitis (HSP, drug reaction)
Work-Up
- CBC
- ECG
- CXR
- ESR, CRP
Treatment
- Penicillin
- Indicated for all pts w/ rheumatic fever even if cx for strep is negative
- 600K units IM if <27 kg
- 1.2 million units IM if >27 kg
- Penicillin V PO x10d
- Prophylaxis
- 5yr if no cardiac involvement, lifetime if cardiac involvement
- Pen G IM q month or oral penicillin daily
- Erythromycin x10d if pen allergic
- Arthritis
- High-dose aspirin therapy (75-100 mg/kg/d)
- Carditis
- Prednisone 1-2mg/kg/d
- Chorea
- Haloperidol 0.01-0.03 mg/kg/d in four divided doses
Disposition
- Admit for confirmation of diagnosis
Source
Tintinalli