Rheum Fever

Peak incidence 5-15years

Occurs 2-4 weeks after infection with a lancfiel A beta haemolytic strep
Occurs due to antibody against bacterial carbohydrate cell wall cross reacing with
valve tissue

Diagnosis - Revised Jones Criteria

Evidence of infection with lancefield A beta haemolytic strep:

Positive throat culture

Rapid streptococcalantigen test
Elevated or rising streptococal antibody titre
Recent scarlet fever

+ 2 major:

Carditis - tachycardia, murmur (AR, MR, carey combs - short mid-diastolic rumble
heard at apex sign of mitral vulvitis), pericardial rub, heart failure,
conduction defects, or an apical systolic murmur (may be only sign)
Migrating polyarthritis of large joints
Painless mobile subcutaneous nodules on extensor surfaces
Erythema marginatum; red raised rash with clear center on arms, thighs and trunk
Sydenham's chorea: uni or bilater semi-perpuosful movements

or + 1major and two minor:

Fever
Raised ESR or CRP
Arthralgia (not if arthritis is major)
Prolonged PR (not if carditis is major)
Previous rheumatic fever

Management:

Bed rest until CRP normal for 2 weeks

Benzylpenecillin IV stat then PO penecillin V QDS for 10 days
Analgesia: Aspirin + Prednisolon if moderate to severe carditis is present
Immobilize joints in severe arthritis
Diazepam for chorea

Secondary Prophylaxis: Penicillin V 250mg BD or Erythromycin 250mg BD which is

continued:

- Until age 40yrs if carditis and valve disease present

- For 10 years if carditis only is present
- For 5 years if neither carditis nor valve disease is present

Note:

60% of patients with carditis develop chronic rheumatic heart disease

Acute attacks last an average of three months
Relapses can be triggered by streptococcal infetions, pregnancy and the pill
Incompetent valve lesions occur during the attack, stenosis years later; mitral
70%, aortic 40%, tircuspid 10%, pulmonary 2%