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Acute Rheumatic Fever — EECC MCQ

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EasyGeneral CardiologyAcute Rheumatic FeverEECC

A 10-year-old boy from India presents with fever, migratory polyarthritis, and a new pansystolic murmur at the apex. His throat swab is positive for Group A Streptococcus, ASO titre is markedly elevated, and CRP and ESR are raised. Echocardiography shows moderate mitral regurgitation with leaflet thickening. What is the diagnosis and long-term management?

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Correct answer: B — Acute rheumatic fever (ARF) with carditis — requires treatment of the acute episode and long-term secondary prophylaxis with penicillin to prevent recurrence and progressive valve damage

This is acute rheumatic fever (ARF) meeting the revised Jones criteria: major criteria (migratory polyarthritis, carditis — new MR murmur) and evidence of preceding streptococcal infection (positive throat culture, elevated ASO). Acute management includes: (1) bed rest, (2) anti-inflammatory therapy (aspirin or naproxen; corticosteroids for severe carditis), (3) antibiotic treatment of streptococcal infection (penicillin V or IM benzathine penicillin). Long-term secondary prophylaxis with intramuscular benzathine penicillin every 3-4 weeks is essential to prevent recurrence, as each episode of ARF risks cumulative valve damage leading to chronic rheumatic heart disease (the most common cause of valvular heart disease globally). Duration of prophylaxis depends on severity: at least 10 years or until age 25 (whichever is longer) for carditis with residual valve disease.

Reference: AHA Scientific Statement on Rheumatic Fever; WHO Guidelines on ARF/RHD