Rheumatic fever is inflammatory disease that involving heart, joints, skin or brain. It is more commonly found in the developing countries due to cross sensitivity reaction to beta hemolytic streptococci. It can develop 2-3 weeks after streptococcal upper respiratory tract infection.
Medications:
- Cap. Mox 500 (Amoxicillin 500 mg) 1 capsule thrice a day for 10 days.
- Tab. Ecosprin 325 (Aspirin 325 mg) – First 2 weeks: 100 mg/kg/day in divided doses. Max dose: 6-8 grams/day. Next 6 weeks: 60 mg/kg/day in divided doses.
- Tab. Pantakind 40 (Pantoprazole 40 mg) 1 tablet once a day while taking steroids and aspirin.
- Inj. Penidure LA 12 (Benzathine Penicillin 12,00,000 I.U.) deep intramuscularly each month until age of 21 years or indefinitely if valvular damage present.
If patient presents with signs of carditis (new onset murmur, vegetations on the valves etc.) consider 6 weeks course of tab. Zempred 4 (Methylprednisolone 4 mg) as below:
- Week 1 – 2 tablets before breakfast, 1 tablet each after lunch, dinner and at bedtime (total dose 24 mg per day).
- Week 2 – 1 tablet before breakfast, 1 tablet each after lunch and dinner, 2 tablets at bedtime (total dose 20 mg per day).
- Week 3 – 1 tablet before breakfast, 1 tablet each after lunch, dinner and at bedtime (total dose 16 mg per day).
- Week 4 – 1 tablet before breakfast, 1 tablet each after lunch and at bedtime (total dose 12 mg per day).
- Week 5 – 1 tablet before breakfast and at bedtime (total dose 8 mg per day).
- Week 6 – 1 tablet before breakfast (total dose 4 mg per day).
Investigations:
- Complete blood count – to evaluate extent of infection
- ESR – to assess inflammatory process
- C reactive protein – to assess extent of sepsis
- ASO titre – to grade rheumatic fever
- ECG – to rule out ischaemia or arrhythmias
- Chest X ray – to rule out cardiomegaly
- Echocardiogram – to assess the valvular damage, vegetations and cardiac function
- Throat swab – to isolate the organisms and for antibiotic sensitivity
Jones criteria – Rheumatic fever is considered if either 2 major criteria or 1 major and 2 minor criteria are met or if there is evidence of streptococcal infection:
- Major criteria – carditis, polyarthritis, erythema marginatum, subcutaneous nodules, chorea (purposeless, rapid, involuntary movements, emotionally labile, and muscular weakness).
- Minor criteria – fever/ raised ESR /CRP, arthralgia, increased PR interval on ECG, positive history.
Referral:
All these cases are to be referred to cardiologist for long term care.