ACUTE RHEUMATIC
FEVER
APPLIED EXERCISE
CASE SCENARIO
A 7- year old female child presented to the Cardiology OPD with swollen,
red and/ or tender joints, which migrates from one joint to another (knees,
ankles, hips & elbows) over a period of hours. The child was having an
abnormal gait. She also complained of painless, small, mobile lumps
beneath the skin overlying bony prominences, particularly of the hands, feet
& elbows. On auscultation, murmur was heard over the mitral valve area.
ECG showed prolonged P- R interval. On inquiry, it was found that the child
had an episode of sore throat 3 weeks back.
Comment on:
1. What is the probable clinical diagnosis & its etiological agent?
The probable clinical diagnosis is Acute rheumatic fever caused by Group A
Streptococcus.
2. Describe the diagnostic criteria used for this
condition.
Diagnostic criteria for rheumatic fever —modified Jones criteria (2015)
Diagnostic criteria for rheumatic fever —modified
Jones criteria (2015)
3. The serotypes involved.
Group A Streptococci (usually by M-serotypes 1, 3, 5, 6, 14, 18, 19, 24, 27
and 29).
4. How will you prevent the recurrence of such
episodes?
Primary Prevention:
Includes timely and complete treatment of group A streptococcal sore throat
with antibiotics (penicillin) within 9 days of sore throat onset.
Prevention
Secondary Prevention:
Long-term penicillin prophylaxis - indicated to prevent recurrences.
Drug of choice for secondary prophylaxis is intramuscular benzathine
penicillin G given every 4 weeks.
Penicillin allergy - erythromycin (250 mg, twice a day).
The duration depends upon underlying carditis.
Secondary prophyllaxis
Drug Dose Route
Benzathine 6 lakh IU for Intramuscular
Penicillin G children
weighing≤60 lb
1.2 million IU for
children weighing>
60lb, every 4 wkly
OR
Penicillin V 250mg, twice a day Oral
OR
Sulfadiazine or 0.5g, once a day Oral
sulfisoxazole for patients
weighing ≤60 lb
1g, once a day for
patients weighing
> 60lb
For people allergic to penicillin & sulfonamide drugs,
Macrolide or Variable Oral
Duration of prophyllaxis for people who
have had ARF
Category Duration
RF without carditis 5 yr or until 21yr of age,
whichever is longer.
RF with carditis but without 10 yr or until 21 yr of age,
valvular disease whichever is longer.
Rf with carditis & residual 10 yr or until 40 yr of age,
heart disease whichever is longer,
sometimes lifelong
prophyllaxis.
