Q&A COUNT: 31
JONES criteria
2 major (or) 1 major + 2 minor criteria with evidence of streptococcal infection
JONES criteria
2 major (or) 1 major + 2 minor criteria with evidence of streptococcal infection
Major Criteria:
- Joints (Migratory Polyarthritis)
- Clinical Pan-Carditis*
- Subcutaneous nodules
- Sydenham's Chorea
- Erythema marginatum
- Fever
- Arthralgia
- Elevated CRP or ESR or Leukocytosis
- Prolonged PR interval (ECG)
Essential criteria or evidence of antecedent Streptococcal infection:
1. ASO titre (or)
2. Streptococci group A throat culture (or)
3. Anti DNase B titer (or)
4. Recent scarlet fever/streptococcal sore throat (or)
5. Rapid Streptococcal antigen detection test
4. Recent scarlet fever/streptococcal sore throat (or)
5. Rapid Streptococcal antigen detection test
What is Modified or REVISED DUCKETT JONES criteria?
Seperate criteria for moderate/high risk and low risk populations
Main changes compared to old criteria:
Carditis - Including Subclinical Carditis as major criteria. Above old criteria includes only Clinical carditis. Now, Echocardiogram is recommended for all cases to identify subclinical carditis also.
*There is an Echo criteria for subclinical carditis given below
Joints - Polyarthritis , Polyarthralgia and Monoarthritis are considered under Major criteria. Only monoarthralgia is considered under Minor criteria (for low risk populations only)
Fever cutoff reduced to 38°C and above (low risk). ESR cutoff changed.
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| Criteria: 2 major (or) 1 major + 2 minor with evidence of antecedent streptococcal infection (Picture taken from Google search) |
Main changes compared to old criteria:
Carditis - Including Subclinical Carditis as major criteria. Above old criteria includes only Clinical carditis. Now, Echocardiogram is recommended for all cases to identify subclinical carditis also.
*There is an Echo criteria for subclinical carditis given below
Joints - Polyarthritis , Polyarthralgia and Monoarthritis are considered under Major criteria. Only monoarthralgia is considered under Minor criteria (for low risk populations only)
Fever cutoff reduced to 38°C and above (low risk). ESR cutoff changed.
Exceptions for JONES criteria
- Chorea (manifests late)
- Subacute chronic carditis (here, all acute reactants go negative)
- Recurrence
Percentage of occurence of features in JONES criteria
- Arthritis (60% of patients)
- Carditis (40%)
- Subcutaneous nodules (5%)
- Chorea (10%)
- Erythema marginatum (<1%)
SORE THROAT:
Duration to treat Streptococcal sore throat
7-10 days
Character of Streptococcal Sore Throat
- There will be high grade fever
- Tonsillitis
- Pus from tonsils
- Palatal petechiae
- Membranous tonsillitis
ASO titre value
Children 5-15 yrs: >333 Todd units per mL
Adults: >250 Todd units per mL
Anti DNase B titre value
Preschool child - 1:60 units
School child - 1:480 units
Adults - 1:340 units
ARTHRITIS:
Causes of Arthritis
Characteristics of Rheumatic Arthritis
1. Migratory (first affects one joint - after 2-7 days, the affected joint will be resolved and another large joint is affected)
2. Affects large joints
3. Asymmetrical
4. No residual defects after resolution
5. No diurnal variation
6. Responds well to Salicylates
7. Age: Children 5-15 years
*Note: All these points are opposite in a case of Rheumatoid** arthritis
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| The above picture is taken from OP Ghai Textbook of Paediatrics |
Characteristics of Rheumatic Arthritis
1. Migratory (first affects one joint - after 2-7 days, the affected joint will be resolved and another large joint is affected)
2. Affects large joints
3. Asymmetrical
4. No residual defects after resolution
5. No diurnal variation
6. Responds well to Salicylates
7. Age: Children 5-15 years
*Note: All these points are opposite in a case of Rheumatoid** arthritis
What is Jaccoud's arthritis?
(A) Normally, Rheumatic arthritis has no residual damage once it is resolved
But - Jaccoud's arthritis occurs as a rare, chronic, post rheumatic swelling of small joints
It is a residual defect of Rheumatic arthritis.
It is a residual defect of Rheumatic arthritis.
How to differentiate arthritis of SLE and RF?
RF arthritis - no residual joint damage and it responds to Salicylates
Vice versa in SLE arthritis
Migratory SMALL joint arthritis seen in?
Collagen disease
Migratory large joint arthritis seen in?
Rheumatic fever
RF arthritis resolving duration
4-6 weeks
OTHER CRITERIA:
Erythema marginatum - character:
- Non pruritic
- Swimming suit distribution
- Not visible in dark skinned
- Serpenginous margin
Erythema chronic migrans occurs in?
It occurs in Lyme disease
It occurs in Lyme disease
Atypical features of RF:
- Malaise
- Epistaxis
- Fatigue
- Abdominal pain
- Anemia
- Skin rashes
- Respiratory problems
When will chorea occur?
After 3 months of RF (late manifestation)
Associated with hypotonia, emotional disturbance, proximal muscles are affected
Features of PANCARDITIS
Endocarditis - Variable murmurs, Fever
Myocarditis - Heart Failure, High Sleeping PR
Pericarditis - Chest pain, Pericardial rub
Myocarditis - Heart Failure, High Sleeping PR
Pericarditis - Chest pain, Pericardial rub
Subcutaneous nodules in RF:
- Sites - Extensor aspect of elbow , Occiput , Popliteal fossa
- Non tender
- Pea sized (0.5-1 mm)
- Freely mobile
- Comes in crops (2-3 nodules)
EXAMINATION:
How all the six GE features are possible in a case of RF?
- Pallor - due to anemia in 50% cases
- Icterus - due to CCF causing congestive hepatomegaly
- Clubbing - in chronic RHD with a recent recurrence of RF
- Cyanosis - RF + IE
- Edema - due to CCF
- Lymphadenopathy - associated IE
What are the peripheral and systemic signs of Infective Endocarditis?
Systemic signs:
1. Rise in temperature
2. Pallor
Peripheral signs:
Skin - Osler nodes, Janeway lesions, Splinter nail bed hemorrhages, Petechiae, Necrotic skin lesions
Eye - Roth spots, Flame shaped or Petechial hemorrhages, Papilloedema
Digits - Gangrene, Clubbing
Nervous system - Hemiplegia
Abdomen - Tender splenomegaly, abdominal pain
CVS - Changing murmurs, Tachycardia
1. Rise in temperature
2. Pallor
Peripheral signs:
Skin - Osler nodes, Janeway lesions, Splinter nail bed hemorrhages, Petechiae, Necrotic skin lesions
Eye - Roth spots, Flame shaped or Petechial hemorrhages, Papilloedema
Digits - Gangrene, Clubbing
Nervous system - Hemiplegia
Abdomen - Tender splenomegaly, abdominal pain
CVS - Changing murmurs, Tachycardia
Importance of Sleeping Pulse Rate in RF:
Elevated in Myocarditis
MANAGEMENT:
Treatment of Rheumatic Fever
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| The above picture is taken from Aruchamy Textbook of Paediatrics |
Define Primary, Secondary, Tertiary prophylaxis - RF
Primary prophylaxis - Early recognition and treatment of streptococcal sore throat, even before the first attack of RF
Secondary prophylaxis - Prevention of recurrent attacks of Rheumatic fever, after the first attack
Tertiary prophylaxis - Prevention of Infective endocarditis in children with pre-existing Rheumatic valvular disease
Primary Prophylaxis in Rheumatic Fever
Primary prophylaxis - Early recognition and treatment of streptococcal sore throat, even before the first attack of RF
Secondary Prophylaxis in Rheumatic Fever
Secondary prophylaxis - Prevention of recurrent attacks of Rheumatic fever, after the first attack
Primary prophylaxis - Early recognition and treatment of streptococcal sore throat, even before the first attack of RF
Secondary prophylaxis - Prevention of recurrent attacks of Rheumatic fever, after the first attack
Tertiary prophylaxis - Prevention of Infective endocarditis in children with pre-existing Rheumatic valvular disease
Primary Prophylaxis in Rheumatic Fever
Primary prophylaxis - Early recognition and treatment of streptococcal sore throat, even before the first attack of RF
 |
| The above picture is taken from Aruchamy Textbook of Paediatrics |
Secondary Prophylaxis in Rheumatic Fever
Secondary prophylaxis - Prevention of recurrent attacks of Rheumatic fever, after the first attack
 |
| The above picture is taken from Aruchamy Textbook of Paediatrics |
 |
| The above picture is taken from Aruchamy Textbook of Paediatrics |
Tertiary Prophylaxis in Rheumatic Fever
Tertiary prophylaxis - Prevention of Infective endocarditis in children with pre-existing Rheumatic valvular disease
Measures:
1. Prophylactic antibiotics given before surgical procedures like dental extraction
2. Surgical correction or replacement of valves
Tertiary prophylaxis - Prevention of Infective endocarditis in children with pre-existing Rheumatic valvular disease
Measures:
1. Prophylactic antibiotics given before surgical procedures like dental extraction
2. Surgical correction or replacement of valves
Echo criteria of subclinical Carditis
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| The above picture is taken from Google search |