Acute Rheumatic Fever

Clinical Description

Multisystem condition resulting from immune response to group B streptococcus throat infection

Signs and Symptoms

New revised Jones criteria

• 1. Evidence of preceding Group A strep throat infection
• 2. Major criteria
• a. Carditis
• b. Polyarthritis/polyarthralgia
• c. Subcutaneous nodules
• d. Erythema marginatum
• e. Sydenham’s chorea
• 3. Minor criteria
• a. Fever >38°C
• b. Raised acute phase reactants, ESR>30mm/hr., CRP>3
• c. Prolonged PR interval
• d. Monoarthralgia

To make diagnosis you need one major and 2 minor or 2 major or 3 minor criteria

Investigations

• FBC, ESR, CRP, Anti-Streptolysin O titer, Throat swab, ECG, Echocardiograph

Pharmacological

Acute management

• Penicillin V Potassium <5years 250mg PO 6 hourly >5years 500mg BD for 10days
• Aspirin 25mg/kg 6 hourly for at least 14 days

If persistent fevers, joint pains consider steroids

• Bedrest for 14 days
• Chorea: Haloperidol 25 micrograms/kg daily
• If not responding, sodium valproate 20mg/kg twice daily, titrate according to response
• or Phenobarbital 5mg/kg once daily

Long term

• Antibiotic prophylaxis, Benzathine Penicillin 0.6MU IM < 30kg, 1.2MU > 30kg IM

STAT monthly

• Follow up in pediatric clinic

Complications

• Rheumatic heart disease
• Valvular damage

Complications and Referral Criteria

• Children with complications of acute rheumatic fever
• Children with Persistent symptoms