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Rheumatic Fever, Pediatric

Shashank P. Behere, MD and David Hehir, MD, MS Reviewed 10/2018
 


BASICS

DESCRIPTION

  • A postinfectious inflammatory disease caused by rheumatogenic strains of group A β-hemolytic Streptococcus (GABHS)

  • Acute rheumatic fever (ARF) results in a wide range of disease, from...

DIAGNOSIS

HISTORY

Diagnosis is based on the modified Jones criteria (updated 2015): 
  • Evidence of recent GABHS infection PLUS two major OR one major and two minor criteria for initial ARF; as above, OR t...

TREATMENT

MEDICATION

First Line

  • Anti-inflammatory

    • Aspirin 100 mg/kg/24 h PO divided q6–8h; may be reduced to 60 to 70 mg/kg/24 h when fever and acute-phase reactants have normalized for 6 to 8 weeks

  • Antib...

ONGOING CARE

FOLLOW-UP RECOMMENDATIONS

  • Patients without carditis

    • Close follow-up is needed for 2 to 3 weeks to assess patient’s condition for development of acute carditis.

    • Long-term pediatric follow-up ...

ADDITIONAL READING

  • Cilliers A, Manyemba J, Adler AJ, et al. Anti-inflammatory treatment for carditis in acute rheumatic fever. Cochrane Database Syst Rev.  2012;(6): CD003176. [View Abstract on O...

CODES

ICD9

  • 390 Rheumatic fever without mention of heart involvement

  • 398.90 Rheumatic heart disease, unspecified

  • 714.0 Rheumatoid arthritis

  • 391.9 Acute rheumatic heart disease, unspecified

ICD10

  • I00 Rheumati...

FAQ

  • Q: Does a negative throat culture rule out ARF?

  • A: No. Throat cultures may be negative in 2/3 of patients.

  • Q: Is there a vaccine available that is effective in preventing ARF?

  • A: Not at present. Give...

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