Paediatrics rheumatic fever: Clinical features, mangament

2021-03-05 12:00 AM

This is an important cause of heart disease worldwide but is rarely seen in developed countries. Acute rheumatic fever (ARF) develops in response to infection with group A B-haemolytic streptococcus.

Paediatrics rheumatic fever

Paediatrics: Rheumatic fever

Rheumatic fever

This is an important cause of heart disease worldwide but is rarely seen in developed countries. Acute rheumatic fever (ARF) develops in response to infection with group A B-haemolytic streptococcus.  It is seen in children aged from 5 to 15 years old and the incidence is highest in those from socially and economically disadvantaged areas.

Clinical features

There is a latent period from 2 to 6 weeks between the onset of symptoms and previous streptococcal infection (e.g. pharyngitis).

Symptoms are non-specific.

The grouping together of clinical features makes the diagnosis more likely (Jones criteria).

These are categorized into major or minor.

Diagnosis of ARF

Two major features; or

One major + two minor features; and

Evidence of previous group A streptococcal infection.

Management

In the acute phase treatment will include:

Bed rest;

Anti-inflammatory drugs (e.g. aspirin);

Corticosteroids (from 2 to 3 weeks);

Diuretics/ACE inhibitors if in heart failure;

Antibiotics (e.g. penicillin V for 10 days).

Long-term therapy:

Long-term therapy is aimed at s prevention of further attacks of acute rheumatic fever and the development of chronic rheumatic heart disease. Antibiotic prophylaxis (daily oral penicillin, or monthly IM penicillin G) is recommended.

Chronic rheumatic heart disease

Recurrent bouts of ARF with associated carditis result in scarring and fibrosis of the heart valves (most commonly mitral valve) and may result in incompetent valves requiring replacement.