Paediatric-History taking & Physical examination of acute rheumatic fever (ARF)

Paediatric-History taking & Physical examination of acute rheumatic fever (ARF)Created OnApril 27, 2020Last Updated OnApril 27, 2020byadmin You are here: Main Clinical Examination Paediatric-History taking & Physical examination of acute rheumatic fever (ARF) < All Topics Table of Contents Diagnosis – Modified Jones criteria: Initial episode of ARF: {2 major} or {1 major and 2 minor} criteria + Evidence of preceding group A streptococcal infection Recurrent attack of ARF (known past ARF or RHD): {2 major} or {1 major and 2 minor} or {3 minor} criteria + Evidence of preceding group A streptococcal infection Major criteria Minor criteria Carditis Polyarthritis, aseptic monoarthritis or polyarthralgia Sydenham chorea Erythema marginatum Subcutaneous nodules Fever (Temp >38 °C) ESR >30mm/h or CRP >30mg/L Prolonged PR interval on ECG History taking: A history of group A streptococcal infection 2-6 weeks ago Arthritis: Onset: Earliest symptomatic manifestation of ARF Generally presenting within 21 days of GAS infection, although asymptomatic carditis may develop first Epidemiology: More common and more severe in teenagers and young adults than in children Sites most commonly affected: Knees, ankles, elbows, and wrists (leg joints typically affected first) Duration: Inflammation affects several joints in quick succession, and each joint is inflamed for 1-2 days to a week Onset of arthritis in different joints usually overlaps, giving the appearance that the disease “migrates” from joint to joint. Hence, the term “migratory” polyarthritis in ARF Severity: Joint pain typically is more prominent than objective signs of inflammation and is almost always transient. However, the arthritis may be severe enough to severely limit movement Prognosis: Resolves without treatment in approximately 4 weeks No long-term joint deformity Carditis Predominant manifestation → Endocardial involvement presenting as valvulitis, particularly affecting the mitral and aortic valves Usually presents within 3 weeks of infection Presence of valvulitis is established by auscultatory + echocardiographic evidence of MR or AR MR – apical PSM +/- AR – basal EDM +/- Carey-Coombs murmur – apical MDM An indicator of moderate-severe MR as a result of increased blood flow across the mitral valve during left ventricular filling Pericarditis occurs in approximately 15% of cases of ARF and may present with precordial chest pain and a pericardial friction rub. May be transient and generally resolves without sequelae Sydenham chorea A neurologic disorder consisting of abrupt, non-rhythmic, involuntary movements, muscular weakness, and emotional disturbances Onset: Typically presents 1-8 months after group A streptococcal infection Epidemiology: More common in girls and may present as refusal to go to school and self-isolation due to shame and embarrassment Site: Frequently are more marked on one side, are occasionally unilateral (hemichorea) Head – Erratic movements of the face that resemble grimaces, grins, and frowns Tongue – Resemble a “bag of worms” when protruded, and protrusion cannot be maintained Character and timing: Subtle and intermittent movements May only be seen after a...

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