Department of Clinical EpidemiologyUniversity of Santo Tomas

Faculty of Medicine and Surgery

Case 1: Acute Rheumatic Fever

Cueto, Mary Anne to Diaz, Cristina Group 1 – 3B

Clinical Decision on a DIAGNOSTIC TEST

Case Scenario• E.C., a 28 year old housewife was admitted

because of dyspnea. Three days ago, she had dental extraction then the next day she began coughing productive of yellowish sputum. She also had chest pain radiating to the back lasting for 30 mins and occurring even at rest. She is febrile (38 C) with joint pain and myalgia. The Past Medical History - frequent streptococcal throat infection in childhood; at age 16 years diagnosed to have valvular heart disease and given monthly Benzathine Penicillin.

Salient Features• 28 year old housewife• Dyspnea• History of dental extraction 3 days ago• Productive cough• Yellowish sputum• Unstable angina• Febrile• Joint pain• Myalgia• Past medical history of frequent streptococcal throat

infection as a child• Valvular heart disease

Acute Rheumatic Fever and Rheumatic Heart Disease on the Navajo Reservation, 1962-77. JOHN COULEHAN, MD, SHELLIE GRANT, MD, KEITH REISINGER, MD, PAUL KILLIAN, MD, KENNETH D. ROGERS, MD, CHARLES KALTENBACH, DrPH

Modified Jones Criteria

• Presence of two major or one major and two minor, plus evidence of antecedent group A streptococcus infection.

Major criteria Minor criteriaCarditisPolyarthritisChoreaErythema marginatumSubcutaneous nodules

ArthralgiaFeverRaised erythrocyte sedimentation rate or Creactiveprotein concentrationsProlonged PR interval on electrocardiogram

Plus evidence of recent streptococcal infection

Differential DiagnosisPresentation

Polyarthritis and fever Carditis

Septic arthritisCT and other autoimmune disorderViral arthropathyReactive arthropathyLyme diseaseSickle cell anemiaInfective carditisLeukemia or lymphomaGout and pseudogout

Innocent murmurMitral valve prolapseCongenital heart diseaseInfective endocarditisHypertrophic cardiomyopathyMyocarditispericarditis

Clinical Question

How useful is echocardiography in the evaluation of a 28 year old female presenting with signs and symptoms of acute rheumatic fever?

• Population: Population: 452 patients with acute rheumatic fever diagnosed by Jones criteria, 230 males and 222 females, age range from 1 yr 11mos to 51 years old

• Intervention: Echocardiographic diagnostic procedure• outcome: incremental role of echocardiography

Search terms: Echocardiography, acute rheumatic fever, adult

Journal Title: The Role of Echocardiography in Diagnosing Carditis in the Setting of Acute Rheumatic FeverIshwarappa B. Vijayalakshmi, Jayapal Mithravinda, Arale N. Prabhu DevaSpectrum of Disease

Spectrum of Disease: Ectopic Pregnancy

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