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
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