Which of the following manifestation of rheumatic fever disappears completely?
Ref: Nelson's Textbook of Pediatrics. 19th EditionExplanation:Clinical Features of Rheumatic FeverMigratory PolyarthritisArthritis occurs in about 75% of patientsInvolves larger joints, particularly the knees, ankles, wrists, and elbows.Involvement of the spine, small joints of the hands and feet, or hips is uncommon.Affected joints are Hot. red. swollen, and exquisitely tenderThe joint involvement is migratory in natureSevere arthritis can persist for several weeks in untreated patients.A dramatic response to even small doses of salicylates is a characteristic featureAbsence of such a response to salicylates should suggest an alternative diagnosis.Rheumatic arthritis is typically not deforming and disappears completely without any permanent changesSynovial fluid in acute rheumatic fever usually has 10,000-100.000 white blood cells/mnr with a predominance of neutrophils, a protein level of about 4 g/dL. a normal glucose level, and forms a good mucin dot.Frequently, arthritis is the earliest manifestation of acute rheumatic fever and may correlate temporally with peak anti streptococcal antibody titers.There is often an inverse relationship between the severity of arthritis and the severity of cardiac involvement.CarditisCarditis occurs in about 50-60% cases.Pancarditis (active inflammation of myocardium, pericardium, and endocardium)Endocarditis (valvulitis) is a universal findingPresence of pericarditis or myocarditis is variableIsolated mitral valvular disease or combined aortic and mitral valvular diseaseIsolated aortic or right-sided valvular involvement is uncommon.Acute rheumatic carditis usually presents as tachycardia and cardiac murmurs, with or w ithout evidence of myocardial or pericardial involvement.Moderate to severe rheumatic carditis can result in cardiomegaly and congestive heart failure with hepatomegaly and peripheral and pulmonary edema.Echocardiographic findings include pericardial effusion, decreased ventricular contractility, and aortic and/or mitral regurgitation.The major consequence of acute rheumatic carditis is chronic, progressive valvular disease, particularly valvular stenosis.ChoreaOccurs in 10-15% of patientsPresents as an isolated, subtle, neurologic behavior disorder.Symptoms includeEmotional labilityIncoordinationPoor school performanceUncontrollable movementsFacial grimacingSymptoms exacerbated by stress and disappearing with sleepThe latent period from acute GAS infection to chorea is usually longer than for arthritis or carditis and can be months.Onset can he insidious, with symptoms being present for several months before recognition.Clinical maneuvers to elicit features of chorea includeDemonstration of milkmaid's grip t irregular contractions of the muscles of the hands while squeezing the examiner's fingers)Spooning and pronation of the hands when the patient's arms are extendedWormian darting movements of the tongue upon protrusionExamination of handwriting to evaluate.///** motor movements.Chorea does not cause permanent neurologic sequelae.Erythema MarginatumVery rare (<3% cases)Characteristic rash of acute rheumatic fever.Erythematous. Serpiginous, macular lesions with pale centers that are not pruritic11 occurs primariIy on the trunk and extremities. hut not on the faceIt is accentuated on warming the skin.Subcutaneous NodulesVery rare (<1% cases)Firm nodules of 1 cm in diameter along the extensor surfaces of tendons near bony prominences.Assc with severe cardiac involvementMinor ManifestationsThe 2 clinical minor manifestations areArthralgia (in the absence of polyarthritis as a major criterion) andFever (typically temperature >102F and occurring early in the course of illness).The 2 laboratory minor manifestations areElevated acute-phase reactants (CRP & ESR)Prolonged PR interval on ECG (1st degree heart block).Prolonged P-R interval alone does not constitute evidence of carditis or predict long-term cardiac sequelae.Essential criteria (Evidence of recent Group A Streptococcus Infection)An absolute requirement for the diagnosis is supporting evidence of a recent GAS infection.Acute rheumatic fever typically develops 2-4 \vk after an acute episode of GAS pharyngitisElevated or increasing serum anti streptococcal antibody titers.A slide agglutination test (Streptozyme).Single antibody ASLO (antistreptolysin O). is elevated in 80-85% of patientsElevation of any 3 antibodies (antistreptolysin O, anti-DNase B, antihyaluronidasej is seen in 95-100% cases.
Carditis
Arthritis
Chorea
Subcutaneous mnlules
Rheumatic Heart Disease