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39 Cards in this Set

  • Front
  • Back
what is the cardiac damage seen with acute rheumatic fever?

mitral valve stenosis
why do we do a strep test?
because it is associated with acute rheumatic fever! so you want to prevent that shit
Define acute rheumatic fever (ARF)

Delayed nonsupporative disease (no puss)

Occurs after an antecedant Group A streptococcal infection

Characterized by proliferative inflammatory lesions in the connective tissue of joints, heart, skin and central nervous tissue
how long does it take for strep to infect?
18 days
what months does ARF (acute rheumatic fever) occur?
cooler months!

March or April in the NE

fall months in the SW
how do streptococci appear under microscopy
chains of gram positive cocci
are strep catalase positive or negative?
do strep need enrichment with blood to support growth or not?
Need enrichment with blood to support growth
group a Strep undergoes what type of hemolysis?
• Understand the pathogenic mechanism of ARF

Evidence supports an autoimmune phenomenom – molecular mimicry

Immunoglobulin and complement deposits
Heart reactive antibodies in sera
Patients demonstrate greater hyperimmune response to streptococcal antigens
Rheumatic heart valves have been shown to contain infiltrates of T-cells
is there a strong genetic predisposition to ARF?
not really 2-3%
can ARF reoccur?
what must you have before looking at Jones Criteria?
Antecedent group A infection
How do you clinically Diagnose ARF?
lab evidence of recent strep infection + the presence of 2 major or 1 major and 2 minor Jones Criteria
Erythema marginatum
Subcutaneous nodules
Sydenham’s chorea

are examples of what?
Major Jones Criteria
Previous rheumatic fever
Prolonged P-R interval on ECG
Elevated erythrocyte sedimentation rate,
C-reactive protein or leucocytosis

are examples of what?
Minor Jones Criteria
what major jones criteria is most common in ARF? 2nd?
Polyarthritis most common (80% of cases)

Carditis (40-50%)
How do you make a laboratory diagnosis of ARF?
Screen with Streptozyme test, if pos do ASO (>500 units)

Acute phase reactants - elevated in any inflammatory condition, i.e. increased ESR, CRP, PMN’s, etc.
When do you give a patient prednizone?
when they have ARF with severe carditis
what is the typical treatment for ARF?
how do you prevent primary attacks of ARF?

prompt recognition and treatment of strep throat

Throat cultures for Grp A strep
Rapid latex test
DOC: penicillin
how do you prevent secondary attacks of ARF?

long-term prophylaxis with penicillin

these people will keep getting strep throat over and over after having ARF once, so you treat them to prevent this so they don't get ARF again
what is PANDAS?
Pediatric Autoimmune Neurologic Disorders Associated with Streptococcus
what will make you likely to get infective endocarditis?? (most important risk factor)

please describe Infective endocarditis (IE)
Infective endocarditis (IE) is an infection of the native or prosthetic valve or endocardium

It occurs most often in patients with recognized heart disease
Hearts of such patients undergo an edematous, cellular distortion resulting in non-bacterial thrombocytic endocarditis (NBTE) lesions
what are the 4 classifications of infective endocarditis?

Acute infective endocarditis (AIE)

Subacute infective endocarditis (SIE)

IV drug use infective endocarditis

Prosthetic valve endocarditis (PVE)
---Early onset
---Late onset
what is the common organism that causes Acute Infective Endocarditis
Staphylococcus aureus
what is the common organism that causes Subacute Infective Endocarditis
Streptococcus “viridans” grp (α)
what is the common organism that causes endocarditis from Intravenous Drug Users
Staphylococcus aureus
what is the common organism that causes Early Prosthetic Valve Endocarditis
Staphylococcus epidermidis
what is the common organism that causes Late Prosthetic Valve Endocarditis
Streptococcus “viridans”
Read this

Traumatized valves and role of nonbacterial thrombotic vegetations:

Endothelial damage → tissue denuded of collagen → platelets aggragate → fibrin deposits → bacteria colonize → form vegetations → stimulate thrombi → vegetations enlarge (sanctuary for organisms)
it was a pathogenesis slide
vegetations from endothelial damge provides what for organisms?
your pt presents with fever, rigors, prostration, and leucocytosis
Skin may show evidence of embolic pustules or hemorrhage (DIC)
Occassionally, Janeway lesions

what does this person have
Acute Infective Endocarditis
pt comes in and says they are tired and not feeling well. They report weight loss, and have a heart murmor. The patient also has Roth spots in the eye

what do they have?
subacute endocarditis
The patient has splinter hemorrhages and feels ill. What do they have?

subacute endocarditis
will you be able to easily isolate the organism responsible for AIE? what about SIE?
Easy for AIE

Difficult for SIE
in treatment of infective endocarditis, what type of antibiotics should you use?
what should your blood to serum bactericidal levels be in treatment of IE?