Acute rheumatic fever arises due to cross-reaction of antibodies formed against group A beta-hemolytic streptococcus with host cells resulting in systemic manifestations after streptococcal pharyngitis. It is a multisystem disorder.
Rheumatic fever may manifest as pancarditis, mitral regurgitation secondary to functional and structural abnormality of mitral valve, migratory polyarthritis, Sydenham’s chorea, subcutaneous nodules, fever, leukocytosis, among other. Most common cause of death during acute phase is
The rheumatic fever is diagnosed on the basis of Modified Jones’ Criteria. According to this criterion, for diagnosis of rheumatic fever, a patient must present with 2 or more major manifestation or 1major and 2 or more minor manifestations in addition to established history of streptococcal infection.
The major manifestations of rheumatic fever are:
The minor manifestations of rheumatic fever are:
-previous rheumatic fever
-AV block / prolonged PR-interval
The antibiotic of choice for rheumatic fever is benzylpenicillin. It is administered via IM. The dose is 1.2 million IU. The same dose can be given monthly as a prophylaxis against future streptococcal infections in susceptible population.
In case of penicillin allergy, erythromycin or cephalosporin can be administered.
Davidson's Principles and Practice of Medicine
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