3. O/E : tachypnea and tachycardia
T 38.2
P 160
RR 32
BP 100/60
SaO2 94%
4. Lungs clear
CVS S1S2, pansystolic murmur 3/6
heard at apex with radiation to
axilla
Abdomen Soft, normoactive bowel
sounds
5. Left knee is swollen and extremely tender with
warmth & Limited ROM. His right ankle is very swollen
and warm. He has limited subtalar motion. Both his
knee and ankle are very tender even to touch.
12. 12 million
are affected by ARF and
CRHD globally
developing countries are
150 times
more susceptible than
the developed countries
5-14 years
is the most frequent age
group
13. AN INFLAMMATORY DISEASE OF
CHILDHOOD RESULTING FROM
UNTREATED
STREPTOCOCCOCCAL
PHARYNGEAL INFECTION
33. How to make the diagnosis
Initial episode of ARF
2 MAJOR CRITERIA
OR
1 MAJOR CRITERIA
+2 MINOR CRITERIA
+ evidence of a preceding group
A streptococcal infection
34. How to make the diagnosis
Recurrent attack of ARF
2 MAJOR CRITERIA
OR
1 MAJOR CRITERIA
+2 MINOR CRITERIA
OR
3 of a preceding group A
MINOR CRITERIA
+ evidence
streptococcal infection
35. Evidence of a preceding group A
streptococcal infection
Increased antistreptolysin O titre (ASOT)
Positive throat culture for GABHS
Positive rapid antigen detection test
36. J oints - artritis
O bvious - cardiac
N odules - rheumatic
AJ OR
M E rythema marginatum
S ydenham chorea
I nflammatory cells (leukocytosis)
T emperature
R E SR/CRP elevated
MINO R aised PR interval
I tself (Previous Hx of Rheumatic fever)
A thralgia
38. TREATMENT
Anti-Streptococcal Therapy
IV C. Penicillin 50 000U/kg/dose 6H
or
Oral Penicillin V 250 mg 6H (<30kg),
500 mg 6H (>30kg) for 10 days
Oral Erythromycin for 10 days if allergic to penicillin.
43. TREATMENT
Anti-failure medication
Diuretics, ACE inhibitors, digoxin (to be used
with caution).
44. TREATMENT
Secondary prophylaxis
• IM Benzathine Penicillin 0.6 mega units (<30 kg)
or 1.2 mega units (>30 kg) every 3 to 4 weeks.
• Oral Penicillin V 250 mg twice daily.
• Oral Erythromycin 250 mg twice daily if allergic to
Penicillin.
45. TREATMENT
Secondary prophylaxis
Duration of prophylaxis
• Until age 21 years or 5 years after last attack of
ARF whichever was longer
• Lifelong for patients with carditis and valvular
involvement.
46. Summary
Accurate diagnosis is important.
Jones Criteria is a good guideline
Management include post-strep therapy, anti-
inflammatory therapy, anti-failure therapy and
secondary prophylaxis
ARF is a large physical, emotional and financial
burden.
47. In a case of knee swelling..
Don’t forget your stethoscope!
48. References
1. Kumar, Vinay; Abbas, Abul K; Fausto, Nelson; Mitchell, Richard N
(2007), Robbins Basic Pathology (8th ed.), Saunders Elsevier,
pp. 403–6, ISBN 978-1-4160-2973-1.
2. "rheumatic fever" at Dorland's Medical Dictionary
3. Jones, T Duckett (1944). "The diagnosis of rheumatic
fever". JAMA 126(8):481. doi:10.1001/jama.1944.02850430015005.
4. Ferrieri, P (2002). "Proceedings of the Jones Criteria
workshop".Circulation (Jones Criteria Working Group) 106 (19):
2521–3.doi:10.1161/01.CIR.0000037745.65929.FA. PMID 12417554.
5. Parrillo, Steven J. "Rheumatic Fever". eMedicine. DO, FACOEP,
FACEP. Retrieved 2007-07-14.
6. Malaysian Paediatric Protocol, 3rd Edition
