Create an account
Acute Rheumatic fever
of group A streptococcal pharyngitis, including
pharyngitis associated with scarlet fever.
Specific symptoms of Rheumatic fever
• Arthritis that affects numerous joints but emerges in on joint at a
• Abnormal heart beat
• Chest Pain
• Red patches on skin
• Small painless lumps beneath skin
• Rapid, involuntary movements in muscles of extremities or face
Must have two major manifestations or
• One major manifestation and two minor
Exceptions to Jones Criteria
• Chorea may be the sole manifestation of ARF
• Indolent carditis may be the sole manifestation
in patient who fail to seek early medical
• Individuals with a history of ARF should be
presumed to have recurrence
Must have supportive evidence of antecedent
group A Streptococcal pharyngitis
• Positive throat culture
• Positive rapid streptococcal antigen test
• Elevated (especially rising) streptococcal
• Other arthralgias
• Fever: 101 F to 104 F
• Elevated acute phase reactants (ESR and CRP)
• Prolonged PR Interval on ECG
• Prior history of rheumatic fever
• + Streptococcal Antibody Titers:
• AntiDNase B
• + Streptococcal throat culture
• Elevated Acute Phase Reactants (CRP and ESR)
Differential diagnosis (ARF has many systemic manifestations and could be confused with these due to s/s)
• Bacterial endocarditis
• Viral myocarditis
• Systemic Lupus
• Serum Sickness
• Rheumatoid arthritis
• Infectious arthritis
Treatment goals for your pt with ARF
• Symptomatic relief of acute disease
• Eradication of group A beta-hemolytic
• Prophylaxis against future infection to
prevent recurrent cardiac disease
What therapy will slowdown the valvular portion of the disease process
There is no therapy that slows the progression of valvular damage in patients with ARF
Anti-inflammatory agents used for symptomatic relief of ARF
• Aspirin: 4-8 grams qd
• Serum levels at 20-30mg/dl
• Dramatic relief in fever and arthralgias
• Continue until all symptoms are absent and
ESR levels are normalized
Treatment of Carditis:
• Treat heart failure using conventional therapy
• Treat heart block using conventional therapy
• Prednisone 2mg/kg/day
• Valve repair or replacement for non-
responsive heart failure
Antibiotic therapy with penicillin should be started and maintained for at least 10 days, regardless of the presence or absence of pharyngitis at the time of diagnosis.
What ABX should you use to treat a pt with ARF that also has a penicillin allergy?
• PCN allergic patients should be treated with
the goal of antibiotic prophylaxis against Group A Beta-Hemolytic Streptococcus is to prevent recurrence of acute rheumatic fever.
How long should you continue a pt on ABX prophylaxis?
Consensus seems to be that therapy should be continued at least until the patient is a young adult (18-20 years old) or five years following acute manifestation of ARF
According to WHO guidelines Patients with proven carditis should remain on ABX therapy until?
5 years therapy or until age 18
According to WHO guidelines Patients with mild mitral regurgitation should remain on ABX therapy until?
at least 10 years prophylaxis or until age 25
According to WHO guidelines Patients with severe valve
disease/replacement should remain on ABX therapy until?
What is the most severe sequela
Rheumatic heart disease
• Occurs 10-20 years after the original illness
• Major cause of valvular heart disease worldwide
• Likely to occur in at least 50% of patients with carditis on initial presentation
Please allow access to your computer’s microphone to use Voice Recording.
Having trouble? Click here for help.
We can’t access your microphone!
Click the icon above to update your browser permissions and try again
Reload the page to try again!Reload
Press Cmd-0 to reset your zoom
Press Ctrl-0 to reset your zoom
It looks like your browser might be zoomed in or out. Your browser needs to be zoomed to a normal size to record audio.
Please upgrade Flash or install Chrome
to use Voice Recording.
For more help, see our troubleshooting page.
Your microphone is muted
For help fixing this issue, see this FAQ.
Star this term
You can study starred terms together