Acute rheumatic fever - Revision history

Aidan: /* Further Reading */

2026-04-22T15:10:04Z

Aidan: /* Management */

2020-08-22T01:01:14Z

Management

← Older revision		Revision as of 01:01, 22 August 2020
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	==Management==		==Management==

	===Acute ~~management~~===		===Acute Management===

	*Supportive care		*Supportive care
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	*Decolonization, achieved by treating as streptococcal pharyngitis with either benzathine [[penicillin]] G 1.2 MU IM once or [[amoxicillin]] 500 mg PO bid for 10 days		*Decolonization, achieved by treating as streptococcal pharyngitis with either benzathine [[penicillin]] G 1.2 MU IM once or [[amoxicillin]] 500 mg PO bid for 10 days

	===Secondary ~~prevention~~===		===Secondary Prevention===

	*Needed to prevent further infections with [[Streptococcus pyogenes]], which most commonly manifests as [[pharyngitis]] or [[pyoderma]]		*Needed to prevent further infections with [[Streptococcus pyogenes]], which most commonly manifests as [[pharyngitis]] or [[pyoderma]]

Aidan: /* Further Reading */

2020-08-14T18:29:35Z

Further Reading

← Older revision		Revision as of 18:29, 14 August 2020
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	**Still need to exclude other possibilities		**Still need to exclude other possibilities

	== Differential Diagnosis ==		==Differential Diagnosis==

	=== Arthritis ===		===Arthritis===

	* [[Septic arthritis]] including [[gonococcal arthritis]]		*[[Septic arthritis]] including [[gonococcal arthritis]]
	* Connective tissue disease or other autoimmune diseases include [[juvenile idiopathic arthritis]]		*Connective tissue disease or other autoimmune diseases include [[juvenile idiopathic arthritis]]
	* Viral arthropathy		*Viral arthropathy
	* Reactive arthropathy		*Reactive arthropathy
	* [[Lyme disease]]		*[[Lyme disease]]
	* [[Sickle cell anemia]]		*[[Sickle cell anemia]]
	* [[Infective endocarditis]]		*[[Infective endocarditis]]
	* [[Leukemia]] or [[lymphoma]]		*[[Leukemia]] or [[lymphoma]]
	* [[Gout]] or [[pseudogout]]		*[[Gout]] or [[pseudogout]]
	* Post-streptococcal [[reactive arthritis]]		*Post-streptococcal [[reactive arthritis]]
	* [[Henoch-Schonlein purpura]]		*[[Henoch-Schonlein purpura]]

	=== Carditis ===		===Carditis===

	* Physiological [[mitral valve regurgitation]]		*Physiological [[mitral valve regurgitation]]
	* [[Mitral valve prolapse]]		*[[Mitral valve prolapse]]
	* Myxomatous mitral valve		*Myxomatous mitral valve
	* [[Fibroelastoma]]		*[[Fibroelastoma]]
	* Congenital mitral valve disease		*Congenital mitral valve disease
	* Congenital aortic valve disease		*Congenital aortic valve disease
	* [[Infective endocarditis]]		*[[Infective endocarditis]]
	* [[Cardiomyopathy]]		*[[Cardiomyopathy]]
	* [[Myocarditis]] (including viral and idiopathic)		*[[Myocarditis]] (including viral and idiopathic)
	* [[Kawasaki disease]]		*[[Kawasaki disease]]

	=== Chorea ===		===Chorea===

	* Drug intoxication		*Drug intoxication
	* [[Wilson disease]]		*[[Wilson disease]]
	* [[Tic disorder]]		*[[Tic disorder]]
	* Choreoathetoid [[cerebral palsy]]		*Choreoathetoid [[cerebral palsy]]
	* [[Encephalitis]]		*[[Encephalitis]]
	* Familial chorea, including [[Huntington disease]]		*Familial chorea, including [[Huntington disease]]
	* Intracranial tumour		*Intracranial tumour
	* [[Lyme disease]]		*[[Lyme disease]]
	* Hormonal		*Hormonal
	* Metabolic, including Lesch-Nyhan, hyperalaninemia, ataxia-telangiectasia		*Metabolic, including Lesch-Nyhan, hyperalaninemia, ataxia-telangiectasia
	* [[Antiphospholipid antibody syndrome]]		*[[Antiphospholipid antibody syndrome]]
	* [[Systemic lupus erythematosus]]		*[[Systemic lupus erythematosus]]
	* [[Vasculitis]]		*[[Vasculitis]]
	* [[Sarcoidosis]]		*[[Sarcoidosis]]
	* [[Hyperthyroidism]]		*[[Hyperthyroidism]]

	== Diagnosis ==		==Diagnosis==

	* Acute rheumatic fever is diagnosed using the [[modified Jones criteria]]		*Acute rheumatic fever is diagnosed using the [[modified Jones criteria]]

	== Management ==		==Management==

	=== Acute management ===		===Acute management===

	* Supportive care		*Supportive care
	** Arthritis: NSAID, such as [[aspirin]], [[ibuprofen]], or [[naproxen]], until all joint symptoms are resolved		**Arthritis: NSAID, such as [[aspirin]], [[ibuprofen]], or [[naproxen]], until all joint symptoms are resolved
	** Fever: [[acetaminophen]], if desired		**Fever: [[acetaminophen]], if desired
	** Heart failure: diuretics if mild or moderate; add [[ACE inhibitor]] if severe		**Heart failure: diuretics if mild or moderate; add [[ACE inhibitor]] if severe
	** Atrial fibrillation: [[digoxin]]		**Atrial fibrillation: [[digoxin]]
	** Chorea: if moderate, can use [[carbamazepine]] or [[valproate]]; if severe, can add [[risperidone]], [[haloperidol]], or [[diazepam]]; and if persistent or very severe, can add [[prednisone]] or [[methylprednisolone]]		**Chorea: if moderate, can use [[carbamazepine]] or [[valproate]]; if severe, can add [[risperidone]], [[haloperidol]], or [[diazepam]]; and if persistent or very severe, can add [[prednisone]] or [[methylprednisolone]]
	* Decolonization, achieved by treating as streptococcal pharyngitis with either benzathine [[penicillin]] G 1.2 MU IM once or [[amoxicillin]] 500 mg PO bid for 10 days		*Decolonization, achieved by treating as streptococcal pharyngitis with either benzathine [[penicillin]] G 1.2 MU IM once or [[amoxicillin]] 500 mg PO bid for 10 days

	=== Secondary prevention ===		===Secondary prevention===

	* Needed to prevent further infections with [[Streptococcus pyogenes]], which most commonly manifests as [[pharyngitis]] or [[pyoderma]]		*Needed to prevent further infections with [[Streptococcus pyogenes]], which most commonly manifests as [[pharyngitis]] or [[pyoderma]]
	* Choice of antibiotic:		*Choice of antibiotic:
	** The best evidence is [[benzathine penicillin G]] 1.2 MU every 2 to 4 weeks (for adults and children ≥20 kg) or 600 KU (for children <20 kg)		**The best evidence is [[benzathine penicillin G]] 1.2 MU every 2 to 4 weeks (for adults and children ≥20 kg) or 600 KU (for children <20 kg)
	*** Although every 2 weeks provides the best protection, every 3 to 4 weeks is still good (and more common, since it is more acceptable to patients)		***Although every 2 weeks provides the best protection, every 3 to 4 weeks is still good (and more common, since it is more acceptable to patients)
	*** Can, for example, suggest patients get their injection every full moon		***Can, for example, suggest patients get their injection every full moon
	** Alternatively, can use oral [[penicillin V]] 250 mg PO bid		**Alternatively, can use oral [[penicillin V]] 250 mg PO bid
	** If allergy, can use any alternative antibiotic, though they are inferior to [[penicillin]]		**If allergy, can use any alternative antibiotic, though they are inferior to [[penicillin]]
	* Duration, per Australian guidelines:		*Duration, per Australian guidelines:
	** Possible: 12 months, then reassess		**Possible: 12 months, then reassess
	** Probable: for at least 5 years and until at least 21 years of age		**Probable: for at least 5 years and until at least 21 years of age
	** Definite, without carditis: for at least 5 years and until at least 21 years of age		**Definite, without carditis: for at least 5 years and until at least 21 years of age
	** Definite, with carditis:		**Definite, with carditis:
	*** Mild RHD: for at least 10 years (or 5 years if no preceding ARF) and until at least 21 years of age		***Mild RHD: for at least 10 years (or 5 years if no preceding ARF) and until at least 21 years of age
	*** Moderate RHD: for at least 10 years (or 5 years if no preceding ARF) and until at least 35 years of age		***Moderate RHD: for at least 10 years (or 5 years if no preceding ARF) and until at least 35 years of age
	*** Severe RHD: for at least 10 years (or 5 years if no preceding ARF) and until at least 40 years of age		***Severe RHD: for at least 10 years (or 5 years if no preceding ARF) and until at least 40 years of age

	== Further Reading ==		==Further Reading==

	* The 2020 Australian guideline for prevention, diagnosis and management of acute rheumatic fever and rheumatic heart disease (3rd edition). 2020. [https://www.rhdaustralia.org.au/arf-rhd-guideline Available online].		*The 2020 Australian guideline for prevention, diagnosis and management of acute rheumatic fever and rheumatic heart disease (3rd edition). 2020. [https://www.rhdaustralia.org.au/arf-rhd-guideline Available online].
			**Excellent resource with clear, evidence-based guidance.
	* Revision of the Jones Criteria for the Diagnosis of Acute Rheumatic Fever in the Era of Doppler Echocardiography. ''Circulation''. 2015;131:1806-1818. doi: [https://doi.org/10.1161/CIR.0000000000000205 10.1161/CIR.0000000000000205]		*Revision of the Jones Criteria for the Diagnosis of Acute Rheumatic Fever in the Era of Doppler Echocardiography. ''Circulation''. 2015;131:1806-1818. doi: [https://doi.org/10.1161/CIR.0000000000000205 10.1161/CIR.0000000000000205]

	[[Category:Infectious diseases]]		[[Category:Infectious diseases]]

Aidan: /* Secondary prevention */

2020-07-19T13:43:55Z

Secondary prevention

← Older revision		Revision as of 13:43, 19 July 2020
Line 80:		Line 80:
	* Needed to prevent further infections with [[Streptococcus pyogenes]], which most commonly manifests as [[pharyngitis]] or [[pyoderma]]		* Needed to prevent further infections with [[Streptococcus pyogenes]], which most commonly manifests as [[pharyngitis]] or [[pyoderma]]
	* Choice of antibiotic:		* Choice of antibiotic:
	** The best evidence is [[benzathine penicillin G]] ~~900 mg (~~1.2 ~~IU)~~ every 2 to 4 weeks (for adults)		** The best evidence is [[benzathine penicillin G]] 1.2 MU every 2 to 4 weeks (for adults and children ≥20 kg) or 600 KU (for children <20 kg)
	*** Although every 2 weeks provides the best protection, every 3 to 4 weeks is still good (and more common, since it is more acceptable to patients)		*** Although every 2 weeks provides the best protection, every 3 to 4 weeks is still good (and more common, since it is more acceptable to patients)
	*** Can, for example, suggest patients get their injection every full moon		*** Can, for example, suggest patients get their injection every full moon

Aidan: major changes to management, added further reading, and added DDx and Dx

2020-07-19T13:31:27Z

major changes to management, added further reading, and added DDx and Dx

← Older revision		Revision as of 13:31, 19 July 2020
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	== Background ==		==Background==
	* Post-infectious complication of [[Streptococcus pyogenes]] infection
	* Caused by certain serotypes of M protein

			*Post-infectious complication of [[Streptococcus pyogenes]] infection
	== Clinical Manifestation ==
			*Caused by certain serotypes of M protein
	* Presents 1 to 5 weeks following a streptococcal infection

	* Diagnosed using the [[Modified Jones criteria]]
			==Clinical Manifestation==

			*Presents 1 to 5 weeks following a streptococcal infection
			*Clinical syndrome characterized by fever, carditis, polyarticular arthritis, subcutaneous nodules, Sydenham chorea, and erythema marginatum
			**Diagnosed using the [[Modified Jones criteria]]
			*Patients with a history of acute rheumatic fever or rheumatic heart disease may have recurrences with subsequent reinfection with [[Streptococcus pyogenes]]
			**Recurrences do not require as many criteria to diagnose
			**Still need to exclude other possibilities

			== Differential Diagnosis ==

			=== Arthritis ===

			* [[Septic arthritis]] including [[gonococcal arthritis]]
			* Connective tissue disease or other autoimmune diseases include [[juvenile idiopathic arthritis]]
			* Viral arthropathy
			* Reactive arthropathy
			* [[Lyme disease]]
			* [[Sickle cell anemia]]
			* [[Infective endocarditis]]
			* [[Leukemia]] or [[lymphoma]]
			* [[Gout]] or [[pseudogout]]
			* Post-streptococcal [[reactive arthritis]]
			* [[Henoch-Schonlein purpura]]

			=== Carditis ===

			* Physiological [[mitral valve regurgitation]]
			* [[Mitral valve prolapse]]
			* Myxomatous mitral valve
			* [[Fibroelastoma]]
			* Congenital mitral valve disease
			* Congenital aortic valve disease
			* [[Infective endocarditis]]
			* [[Cardiomyopathy]]
			* [[Myocarditis]] (including viral and idiopathic)
			* [[Kawasaki disease]]

			=== Chorea ===

			* Drug intoxication
			* [[Wilson disease]]
			* [[Tic disorder]]
			* Choreoathetoid [[cerebral palsy]]
			* [[Encephalitis]]
			* Familial chorea, including [[Huntington disease]]
			* Intracranial tumour
			* [[Lyme disease]]
			* Hormonal
			* Metabolic, including Lesch-Nyhan, hyperalaninemia, ataxia-telangiectasia
			* [[Antiphospholipid antibody syndrome]]
			* [[Systemic lupus erythematosus]]
			* [[Vasculitis]]
			* [[Sarcoidosis]]
			* [[Hyperthyroidism]]

			== Diagnosis ==

			* Acute rheumatic fever is diagnosed using the [[modified Jones criteria]]

			== Management ==

			=== Acute management ===

			* Supportive care
			** Arthritis: NSAID, such as [[aspirin]], [[ibuprofen]], or [[naproxen]], until all joint symptoms are resolved
			** Fever: [[acetaminophen]], if desired
			** Heart failure: diuretics if mild or moderate; add [[ACE inhibitor]] if severe
			** Atrial fibrillation: [[digoxin]]
			** Chorea: if moderate, can use [[carbamazepine]] or [[valproate]]; if severe, can add [[risperidone]], [[haloperidol]], or [[diazepam]]; and if persistent or very severe, can add [[prednisone]] or [[methylprednisolone]]
			* Decolonization, achieved by treating as streptococcal pharyngitis with either benzathine [[penicillin]] G 1.2 MU IM once or [[amoxicillin]] 500 mg PO bid for 10 days

			=== Secondary prevention ===

			* Needed to prevent further infections with [[Streptococcus pyogenes]], which most commonly manifests as [[pharyngitis]] or [[pyoderma]]
			* Choice of antibiotic:
			** The best evidence is [[benzathine penicillin G]] 900 mg (1.2 IU) every 2 to 4 weeks (for adults)
			*** Although every 2 weeks provides the best protection, every 3 to 4 weeks is still good (and more common, since it is more acceptable to patients)
			*** Can, for example, suggest patients get their injection every full moon
			** Alternatively, can use oral [[penicillin V]] 250 mg PO bid
			** If allergy, can use any alternative antibiotic, though they are inferior to [[penicillin]]
			* Duration, per Australian guidelines:
			** Possible: 12 months, then reassess
			** Probable: for at least 5 years and until at least 21 years of age
			** Definite, without carditis: for at least 5 years and until at least 21 years of age
			** Definite, with carditis:
			*** Mild RHD: for at least 10 years (or 5 years if no preceding ARF) and until at least 21 years of age
			*** Moderate RHD: for at least 10 years (or 5 years if no preceding ARF) and until at least 35 years of age
			*** Severe RHD: for at least 10 years (or 5 years if no preceding ARF) and until at least 40 years of age

			== Further Reading ==

			* The 2020 Australian guideline for prevention, diagnosis and management of acute rheumatic fever and rheumatic heart disease (3rd edition). 2020. [https://www.rhdaustralia.org.au/arf-rhd-guideline Available online].
			* Revision of the Jones Criteria for the Diagnosis of Acute Rheumatic Fever in the Era of Doppler Echocardiography. ''Circulation''. 2015;131:1806-1818. doi: [https://doi.org/10.1161/CIR.0000000000000205 10.1161/CIR.0000000000000205]

	[[Category:Infectious diseases]]		[[Category:Infectious diseases]]

Aidan at 12:14, 19 July 2020

2020-07-19T12:14:49Z

← Older revision		Revision as of 12:14, 19 July 2020
Line 1:		Line 1:
			== Background ==
	* Post-infectious complication of [[Streptococcus pyogenes]] infection		* Post-infectious complication of [[Streptococcus pyogenes]] infection
	* Caused by certain serotypes of M protein		* Caused by certain serotypes of M protein

			== Clinical Manifestation ==
	* Presents 1 to 5 weeks following a streptococcal infection		* Presents 1 to 5 weeks following a streptococcal infection
	* Diagnosed using the [[Modified Jones criteria]]		* Diagnosed using the [[Modified Jones criteria]]

			[[Category:Infectious diseases]]

Aidan: Created page with "* Post-infectious complication of Streptococcus pyogenes infection * Caused by certain serotypes of M protein * Presents 1 to 5 weeks following a streptococcal infection *..."

2019-09-12T13:20:02Z

Created page with "* Post-infectious complication of Streptococcus pyogenes infection * Caused by certain serotypes of M protein * Presents 1 to 5 weeks following a streptococcal infection *..."

New page

* Post-infectious complication of [[Streptococcus pyogenes]] infection
* Caused by certain serotypes of M protein
* Presents 1 to 5 weeks following a streptococcal infection
* Diagnosed using the [[Modified Jones criteria]]

← Older revision		Revision as of 15:10, 22 April 2026
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	==Further Reading==		==Further Reading==

	*The 2020 Australian guideline for prevention, diagnosis and management of acute rheumatic fever and rheumatic heart disease (3rd edition). 2020. [https://~~www.~~rhdaustralia.org.au/arf-rhd-~~guideline~~ Available online].		*The 2020 Australian guideline for prevention, diagnosis and management of acute rheumatic fever and rheumatic heart disease (3rd edition). 2020. [https://rhdaustralia.org.au/arf-rhd-guidelines/ Available online].
	**Excellent resource with clear, evidence-based guidance.		**Excellent resource with clear, evidence-based guidance.
	*Revision of the Jones Criteria for the Diagnosis of Acute Rheumatic Fever in the Era of Doppler Echocardiography. ''Circulation''. 2015;131:1806-1818. doi: [https://doi.org/10.1161/CIR.0000000000000205 10.1161/CIR.0000000000000205]		*Revision of the Jones Criteria for the Diagnosis of Acute Rheumatic Fever in the Era of Doppler Echocardiography. ''Circulation''. 2015;131:1806-1818. doi: [https://doi.org/10.1161/CIR.0000000000000205 10.1161/CIR.0000000000000205]