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Acute Rheumatic Fever
Acute Rheumatic Fever
Commonest cause acquired heart disease in children with peak age 5 – 15 year. Rare < 2 year old.
Preceded by Group A Beta-haemolytic Strep infection (pharynx)
Diagnosis Rhematic Fever (Modified Duckett-Jones Criteria)
| Evidence of previous Strep infection (culture/↑ ASOT) with 2 major or 1 major + 2 minor | |
| Major Criteria | Minor Criteria |
| Carditis Migrating, flitting polyarthritis Sydenham's Chorea Subcutaneous nodules Erythema Marginatum | Fever Arthralgia (if arthritis not present) Raised ESR/CRP Leucocytosis History of previous Rheumatic Heart Disease Prolonged PR interval (if no carditis clinically) |
Failure to meet criteria does not exclude rheumatic fever as criteria apply to the epidemiological definition.
Management
- Admit all patients with suspected RF
- Bed rest until sleeping pulse is normal
- Bloods for FBC/ESR/CRP/blood culture
- Aspirin 75 mg/kg/day in 4 divided doses if symptomatic severe arthritis
- Penicillin VK 250 mg – 500mg 6-hrly oral x 10 days
- Prednisone 2mg/kg/day po in acute carditis (use is controversial)
- Refer to cardiologists for further assessment and follow up at RF clinic
- Needs Bicillin 1.2mu IM monthly or Pen VK 250mg bd till 35yrs old after D/C
- Restrict physical activity for at least 2 weeks after the evidence of rheumatic activity has resolved