Cv: 20. Dugan : Rheumatic Fever & Bacterial Endocarditis

Front 1

what is the cardiac damage seen with acute rheumatic fever?

***

Back 1

mitral valve stenosis

Front 2

why do we do a strep test?

Back 2

because it is associated with acute rheumatic fever! so you want to prevent that shit

Front 3

Define acute rheumatic fever (ARF)

OBJECTIVE ***

Back 3

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

Front 4

how long does it take for strep to infect?

Back 4

18 days

Front 5

what months does ARF (acute rheumatic fever) occur?

Back 5

cooler months!

March or April in the NE

fall months in the SW

Front 6

how do streptococci appear under microscopy

Back 6

chains of gram positive cocci

Front 7

are strep catalase positive or negative?

Back 7

negative

Front 8

do strep need enrichment with blood to support growth or not?

Back 8

Need enrichment with blood to support growth

Front 9

group a Strep undergoes what type of hemolysis?

Back 9

Beta

Front 10

• Understand the pathogenic mechanism of ARF

OBJECTIVE

Back 10

Evidence supports an autoimmune phenomenom – molecular mimicry

examples:
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

Front 11

is there a strong genetic predisposition to ARF?

Back 11

not really 2-3%

Front 12

can ARF reoccur?

Back 12

yes, HIGH PROBABILITY of this

Front 13

what must you have before looking at Jones Criteria?

Back 13

Antecedent group A infection

Front 14

How do you clinically Diagnose ARF?

Back 14

lab evidence of recent strep infection + the presence of 2 major or 1 major and 2 minor Jones Criteria

Front 15

Carditis
Polyarthritis
Erythema marginatum
Subcutaneous nodules
Sydenham’s chorea

are examples of what?

Back 15

Major Jones Criteria

Front 16

Arthralgia
Fever
Previous rheumatic fever
Prolonged P-R interval on ECG
Elevated erythrocyte sedimentation rate,
C-reactive protein or leucocytosis

are examples of what?

Back 16

Minor Jones Criteria

Front 17

what major jones criteria is most common in ARF? 2nd?

Back 17

Polyarthritis most common (80% of cases)

Carditis (40-50%)

Front 18

How do you make a laboratory diagnosis of ARF?

Back 18

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.

Front 19

When do you give a patient prednizone?

Back 19

when they have ARF with severe carditis

Front 20

what is the typical treatment for ARF?

Back 20

Salicylates

Front 21

how do you prevent primary attacks of ARF?

***Objective

Back 21

prompt recognition and treatment of strep throat


Throat cultures for Grp A strep
Rapid latex test
DOC: penicillin

Front 22

how do you prevent secondary attacks of ARF?

***Objective

Back 22

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

Front 23

what is PANDAS?

Back 23

Pediatric Autoimmune Neurologic Disorders Associated with Streptococcus

Front 24

what will make you likely to get infective endocarditis?? (most important risk factor)

*****

Back 24

PRIOR HEART DAMAGE--VALVE DAMAGE

Front 25

please describe Infective endocarditis (IE)

Back 25

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

Front 26

what are the 4 classifications of infective endocarditis?

****KNOW

Back 26

Acute infective endocarditis (AIE)

Subacute infective endocarditis (SIE)

IV drug use infective endocarditis

Prosthetic valve endocarditis (PVE)
---Early onset
---Late onset

Front 27

what is the common organism that causes Acute Infective Endocarditis

Back 27

Staphylococcus aureus

Front 28

what is the common organism that causes Subacute Infective Endocarditis

Back 28

Streptococcus “viridans” grp (α)

Front 29

what is the common organism that causes endocarditis from Intravenous Drug Users

Back 29

Staphylococcus aureus

Front 30

what is the common organism that causes Early Prosthetic Valve Endocarditis

Back 30

Staphylococcus epidermidis

Front 31

what is the common organism that causes Late Prosthetic Valve Endocarditis

Back 31

Streptococcus “viridans”

Front 32

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)

Back 32

it was a pathogenesis slide

Front 33

vegetations from endothelial damge provides what for organisms?

Back 33

SANCTURARY

Front 34

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
*****

Back 34

Acute Infective Endocarditis

Front 35

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?
*****

Back 35

subacute endocarditis

Front 36

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

****

Back 36

subacute endocarditis

Front 37

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

Back 37

Easy for AIE

Difficult for SIE

Front 38

in treatment of infective endocarditis, what type of antibiotics should you use?

Back 38

bactericidial

Front 39

what should your blood to serum bactericidal levels be in treatment of IE?

Back 39

1:8