L6: Acute Rheumatic Fever (Pt 4)

Question 1

TTT of ARF

Question 2

TTT of ARF

• Eradication of streptococcus infection

Answer 2

Question 3

TTT of ARF

• Anti-inflammatory or suppressive therapy

Answer 3

Question 4

TTT of ARF

• Education

Answer 4

Question 5

TTT of ARF

• Bed Rest

Answer 5

Question 6

TTT of ARF

• TTT of Arthritis & Carditis

Answer 6

Question 7

TTT of Arthritis & Carditis

• Arthritis or mild carditis

Answer 7

Question 8

TTT of Arthritis & Carditis

• Severe carditis

Answer 8

Question 9

TTT of ARF

• TTT of CHF

Answer 9

Question 10

TTT of ARF

• TTT of Sydenham’s Chorea

Answer 10

Question 11

TTT of Sydenham’s Chorea

• Rest

Answer 11

Decrease physical & emotional stress and use protective measures

Question 12

TTT of Sydenham’s Chorea

• BPG

Answer 12

Give benzathine penicillin G 1.2 million:
- Initially for eradication of streptococcus
- Every 2 weeks for prevention of recurrence

Question 13

TTT of Sydenham’s Chorea

• Anti-Inflammatory

Answer 13

It is not needed in patients with isolated chorea.

Question 14

TTT of Sydenham’s Chorea

• For Severe Cases

Answer 14

Any of the following drugs may be used:
1. Phenobarbital
2. Haloperidol
3. Valproic acid, chlorpromazine, or diazepam
4. Plasma exchange
5. IV immunoglobulin therapy

Question 15

Without prophylaxis, approximately 25% of patients with isolated chorea (without carditis) develop rheumatic valvular heart disease over a 20-year follow-up period.

Answer 15

….

Question 16

Prevention of ARF

Question 17

Prevention of ARF

• Primary Prevention

Answer 17

• Prevention of the initial attack of acute rheumatic fever.
• By accurate and prompt recognition and treatment of streptococcal pharyngitis

Question 18

Prevention of ARF

• Secondary Prevention

Answer 18

• Prevention of recurrent acute rheumatic fever.
• Through compulsive ongoing prophylaxis against streptococcal infection

Question 19

Prevention of ARF

• Prevention of Bacterial endocarditis

Answer 19

In individuals with residual rheumatic cardiac valve disease

Question 20

Primary Prevention of ARF

• When & For How Long Should Antibiotic be Used?

Answer 20

• 10 days course of penicillin therapy for streptococcal pharyngitis.
• Start antibiotic within 7 to 8 days of the onset of pharyngitis.

Question 21

Primary Prevention of ARF

• Not Possible in

Answer 21

1. Patients who develop subclinical pharyngitis and therefore do not seek medical treatment (30%)
2. patients who develop acute rheumatic fever é out symptoms of streptococcal pharyngitis (30%)

Question 22

Primary Prevention of ARF

• Regimen

Answer 22

Question 23

Primary Prevention of ARF

• Regimen if Allergic to penicillin

Answer 23

Question 24

Primary Prevention of ARF

• What agents are not acceptable?

Answer 24

1. Sulfonamides
2. Trimethoprim
3. Tetracycline
4. Chloramphenicol.

Question 25

Secondary Prevention of **ARF**

Answer 25

Question 26

Secondary Prevention of **ARF** - Indication

Answer 26

is given for all patients with rheumatic fever - including those with isolated chorea & those without RHD.

Question 27

Secondary Prevention of **ARF** - Duration

Answer 27

Question 28

Secondary Prevention of **ARF** - Regimen

Answer 28

Question 29

Secondary Prevention of **ARF** - Regimen (If Allergic to penicillin)

Answer 29

Question 30

Prevention of infective endocarditis

Answer 30

Question 31

Prevention of infective endocarditis - For Who?

Answer 31

Patients with residual RHD after rheumatic fever.

Question 32

Prevention of infective endocarditis - Why?

Answer 32

To prevent lE during invasive procedures.

Question 33

Prevention of infective endocarditis - Invasive Procedures Requiring Prophylaxis

Answer 33

1. Dental cleaning 2. Dental extraction 3. Dental implant 4. Tonsillectomy

Question 34

Prevention of infective endocarditis - Penicillin? | §

Answer 34

Penicillin for rheumatic fever is ineffective for bacterial endocarditis due to resistant oral streptococci.

Question 35

Prevention of infective endocarditis - recommended Antibiotics

Answer 35

1. Clindamycin 2. Erythromycin

Question 36

Prevention of infective endocarditis - Dosage & Timing

Answer 36

A single dose, given 30-60 minutes before the procedure