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1. Immunologic
Streptococcus Beta hemolytic group A
2. Predisposing factors
- Family history
- Socio economic status
- Age 5 -15 years ( peak 8 years)
Inflammatory lesion : heart, brain, joints,
skin
1. Arthritis
* Affects 70 % of cases
* Large joints : knee, ankle, elbow, wrist
* Often > 1 joints, simultaneously or
in succession, migratory
* Swelling, heat, redness, severe pain,
tenderness, motion <
* Dramatic response to salicylate
2. Carditis
50 % of cases, usu within first 3 wks
Diagnosis requires presence of 1 of 4:
- organic heart murmur
- pericarditis (friction rub, pericard
effusion,
chest pain, ECG changes)
- cardiomegaly on chest X ray
- congestive heart failure
3. Erythema marginatum
- <10 % of cases
- Non pruritic annular erythematous rashes,
never on face
- Most prominent on trunk and inner proximal
portions
4. Subcutaneous nodules
- 2-10 % of cases, esp in recurrences
- Hard, painless, non pruritic, freely
ity changes
- spontaneous, purposeless movement
followed by motor weakness
- Dysfunction of basal ganglia and cortical
neuronal components (antineuronal
antibody)
Positive throat culture or rapid streptococcal
antigen tests for group A :
less reliable (recent and chronic infect)
Streptococcal antibody tests : most reliable
- ASTO : 80%
- Anti-DNA se B
- Anti hyaluronidase
Based on
2 major criteria
or + ASTO
1 major + 2 minor
Chorea may occur as the only
manifestations of RF
Indolent carditis may be the only
manifestation
Occasionally patients with RF recurrences
isolated chorea
Recommended anti-inflammatory agents
_______________________________________________________________________________________
Arthritis Mild Moderate Severe
alone carditis carditis carditis
__________________________________________________
Prednisone 0 0 0 2-6 wk*
HF (heart failure)
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