rheumatic%20fever%20-%20acute
RHEUMATIC FEVER - ACUTE
Acute rheumatic fever is an autoimmune response to a previous group A beta-hemolytic streptococcal (GAS) infection causing acute generalized anti-inflammatory response primarily affecting the heart.
It often presents in patients 5-14 years of age and uncommon before 3 years and after 21 years of age.
Patients presenting with acute rheumatic fever are severely unwell, in extreme pain and requires hospitalization.

Definition

Acute Rheumatic Fever (ARF)
  • An autoimmune response to a previous group A beta-hemolytic streptococcal (GAS) infection causing acute generalized anti-inflammatory response primarily affecting the heart
    • It also affects the joints, brain & skin
  • Often presents in patients 5-14 years & uncommon before 3 years & after 21 years
  • Patients presenting w/ ARF are severely unwell, in extreme pain & requires hospitalization

Signs and Symptoms

Initial episode usually occurs 2-4 weeks after GAS infection
  • History of an antecedent sore throat 1-5 weeks prior to onset is present in most patients
  • Increased irritability & shortened attention span w/ personality changes [eg pediatric autoimmune neuropsychiatric disorder associated w/ streptococcal infections (PANDAS)]
Heart
  • Carditis in patient presenting w/ high fever & chest pains
  • Heart failure (HF) w/ respiratory, peripheral or abdominal manifestations
    • Dyspnea w/o rales & hacking, non-productive cough
    • Nausea & vomiting & right upper quadrant or epigastric pain
  • Murmurs
Joints
  • Painful, tender, red, hot & swollen
  • Migratory polyarthritis w/ fever
  • Monoarthritis
  • Arthralgia-like symptoms
  • Tenosynovitis may also be seen
Brain or CNS
  • Sydenham’s chorea
Skin
Signs & symptoms found involving the skin usually develop w/ arthritis, carditis or Sydenham’s chorea
  • Subcutaneous nodules usually on the extensor surface of large joints
  • Erythema marginatum
    • Serpiginous, flat or slightly raised, non-scarring & painless rash
Other
  • Lethargy, malaise & fatigue in HF
  • Pallor
  • Epistaxis
  • Fever
  • Elevated white blood cell (WBC)
  • Abdominal guarding, pain
  • Anorexia
Digital Edition
Asia's trusted medical magazine for healthcare professionals. Get your MIMS Cardiology - Malaysia digital copy today!
Sign In To Download
Editor's Recommendations
Most Read Articles
Yesterday
The appropriate cutoff value in predicting combined cardiovascular outcomes in patients with type 2 diabetes (T2D) is 125 mm Hg for home morning systolic blood pressure (MSBP), suggests a new study.
01 Mar 2015
Red yeast rice extracts have been used in traditional medicine for centuries.1 In recent times, an extract from red yeast rice, Xuezhikang® (XZK), has been studied for its role in dyslipidaemia and cardiovascular disease. This review will look at some of the clinical trials that have done so.
06 Apr 2018

Female patients with coronary artery disease (CAD) have greater regression of coronary atherosclerosis than male patients despite a lower plaque burden at baseline, data from the GLAGOV trial have shown.

26 Apr 2018
Transcatheter aortic valve replacement (TAVR) in severe symptomatic aortic stenosis (AS) patients is superior to conventional surgical aortic valve replacement (SAVR) in terms of reducing life-threatening bleeding, new-onset atrial fibrillation and acute kidney injury, a recent meta-analysis has found.