Rheumatic fever

Clinic

• RF is an inflammatory disease that can involve the heart, joints, skin, and brain.
• The disease typically develops two to four weeks after a Streptococcus pyogenes infection.
• Signs and symptoms include
  • Fever
  • Multiple painful joints,
  • Involuntary muscle movements
  • Occasionally a characteristic non-itchy rash known as erythema marginatum
  • Heart is involvement (50%) causes heart valves damage (Rheumatic heart disease (RHD)), Heart failure, Atrial fibrillation

Signs / Symptoms

A culture positive case of streptococcal pharyngitis with typical tonsillar exudate in a 16-year-old. The disease typically develops two to four weeks after a throat infection. Symptoms include: fever, painful joints with those joints affected changing with time, involuntary muscle movements, and occasionally a characteristic non-itchy rash known as erythema marginatum. The heart is involved in about half of the cases. Damage to the heart valves usually occurs only after multiple attacks but may occasionally occur after a single case of RF. The damaged valves may result in heart failure and also increase the risk of atrial fibrillation and infection of the valves.

Major criteria

1. Joint manifestations are the unique clinical signs that have different implications for different population-risk categories : Only polyarthritis (a temporary migrating inflammation of the large joints, usually starting in the legs and migrating upwards) is considered as a major criterion in low-risk populations, whereas monoarthritis, polyarthritis and polyarthralgia (joint pain without swelling) are all included as major criteria in high-risk populations.
2. Carditis: Carditis can involve the pericardium (pericarditis which resolves without sequelae), some regions of the myocardium (which might not provoke systolic dysfunction), and more consistently the endocardium in the form of valvulitis. Carditis is diagnosed clinically (palpitations, shortness of breath, heart failure, or a new heart murmur) or by echocardiography/Doppler studies revealing mitral or aortic valvulitis. Both of clinical and subclinical carditis are now considered a major criterion.
3. 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.^{[citation needed]}
4. 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.^{[citation needed]}
5. 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

Minor criteria

1. Arthralgia: Polyarthralgia in low-risk populations and monoarthralgia in others. However, joint manifestations cannot be considered in both major and minor categories in the same patient.
2. Fever: ≥ 38.5 °C (101.3 °F) in low-incidence populations and ≥ 38 °C (100.4 °F) in high-risk populations.
3. Raised erythrocyte sedimentation rate (≥60 mm in the first hour in lox-risk populations and ≥30 mm/h in others) or C reactive protein (>3.0 mg/dL).
4. ECG showing a prolonged PR interval after accounting for age variability (Cannot be included if carditis is present as a major symptom)

Related disease

• Erythema marginatum
• Rheumatic fever
• Sydenham's chorea

Miasms

GABHS