11/100. Growing pains: fact or fiction?Growing pains are recurrent limb pains peculiar to children. Brief episodes of leg pains occurring intermittently at night are typical, but the clinical spectrum is variable. A diagnosis of growing pains can be made with certainty only after other possible conditions have been ruled out by appropriate studies and after the child has been observed carefully for a period of months. The two diseases most often confused with this syndrome are rheumatic fever and juvenile rheumatoid arthritis. aspirin and supportive measures are beneficial.- - - - - - - - - - ranking = 1keywords = fever (Clic here for more details about this article) |
12/100. A case of acute rheumatic fever accompanied by transient aortic regurgitation.Though acute rheumatic fever (RF) is now rare in japan, it continues to be an important disease condition that physicians should be prepared to diagnose and treat. We describe a patient with acute RF accompanied by transient aortic regurgitation (AR). The AR was detected only by echocardiography. There were no other indications, and it disappeared after treatment with prednisolone. The changes in cardiac valves in the early phase of RF have been the subject of only a few case studies. echocardiography is quite valuable in the workup of patients with acute RF and should be performed even if there are no signs of cardiac involvement.- - - - - - - - - - ranking = 5keywords = fever (Clic here for more details about this article) |
13/100. Cardiac failure following group A streptococcal infection with echocardiographically proven pericarditis, still insufficient arguments for acute rheumatic fever: a case report and literature update.We recently encountered a 49-year-old female who developed fever due to group A streptococcal (GAS) bacteriaemia spreading to an abscess in the iliac muscle and a bacterial monarthritis of the right knee with a sterile arthritis of her left knee. Treatment was started with a six-week course of intravenous penicillin. She developed a mitral valve insufficiency and pericarditis on the tenth day of admission. In the third week heart failure developed with, on echocardiograph, a high output left ventricular failure without signs of valvulitis or myocarditis. Using a diuretic regimen she was recompensated. Because of the pericarditis with mitral valve insufficiency corticosteroids were given, which had a rapid beneficial effect. A discussion follows on the position of acute rheumatic fever versus post-streptococcal reactive arthritis in this clinical picture and the literature is updated.- - - - - - - - - - ranking = 6keywords = fever (Clic here for more details about this article) |
14/100. Post streptococcal glomerulonephritis co-existing with acute rheumatic fever--a case report.A case of post streptococcal acute glomerulonephritis co-existing with acute rheumatic fever is reported. The relevant literature is briefly reviewed.- - - - - - - - - - ranking = 5keywords = fever (Clic here for more details about this article) |
15/100. Acute encephalomyelitis: extending the neurological manifestations of acute rheumatic fever?The clinical course of a five-year-old boy who developed meningeal irritation, encephalomyelitis, and optic neuritis four weeks after streptococcus pyogenes pharyngitis is detailed. The patient responded to therapy with corticosteroids and recovered fully. review of the literature reveals that a wide range of neurological disorders have been described in association with rheumatic fever. We suggest that disseminated encephalomyelitis in this child most probably was related to the streptococcal infection and that the spectrum of post-infectious neurological disorders associated with streptococcus pyogenes may be broader than is currently appreciated.- - - - - - - - - - ranking = 5keywords = fever (Clic here for more details about this article) |
16/100. rheumatic fever: a case report.The case of a previously healthy nine-year-old female who presented with a two-week history of fever and five days of joint pain is discussed. She was admitted to the hospital, where the diagnosis of acute rheumatic fever was made. Although this diagnosis is made infrequently, it should be part of the differential diagnosis of persistent fever in patients presenting to the Emergency Department.- - - - - - - - - - ranking = 7keywords = fever (Clic here for more details about this article) |
17/100. Acute rheumatic fever without early carditis: an atypical clinical presentation.The original Jones criteria, first introduced in 1944, have been modified four times and updated-revised criteria were published in 1992. A variety of clinical manifestations, which may be the presenting signs and symptoms of acute rheumatic fever, are not included in the updated-revised Jones criteria. A retrospective study was conducted on all children previously diagnosed to have acute rheumatic fever between September 1998 and September 2002. review was focused on clinical presentation; out of 60 medical records reviewed, 4 patients with unusual clinical presentation were recognised and are reported here to highlight the potential diagnostic problems of acute rheumatic fever. They presented with atypical articular involvement, silent carditis and low-grade fever in the presence some time of a positive family history for rheumatic fever. CONCLUSION:a high index of suspicion and an awareness of the absence of early carditis are necessary to make the diagnosis of acute rheumatic fever.- - - - - - - - - - ranking = 10keywords = fever (Clic here for more details about this article) |
18/100. Recurrent acute rheumatic fever: a forgotten diagnosis?The incidence of acute rheumatic fever has seen a dramatic decline over the last 15 to 20 years in most developed countries and treatment of this disease has changed little since. The ease of travel and immigration and the cosmopolitan nature of many cities mean that occasionally the disease will come to the attention of clinicians not familiar with its presentation, resulting in delayed diagnosis and treatment. We present a case of recurrent acute rheumatic fever in a patient who was initially thought to be suffering from acute bacterial endocarditis on her previously diseased rheumatic aortic valve. This culminated in her undergoing urgent aortic valve replacement during a phase of the illness that should have been treated with high dose anti-inflammatory medication. Therefore, clinicians should be aware of this condition and include it in their differential diagnosis of the febrile patient with a previous history of rheumatic fever. We briefly discuss the diagnostic dilemma of patients suffering from this condition and in differentiating it from acute endocarditis.- - - - - - - - - - ranking = 7keywords = fever (Clic here for more details about this article) |
19/100. recurrence of Sydenham chorea: implications for pathogenesis.BACKGROUND: Sydenham chorea (SC), a major sign of rheumatic fever (RF), is related to systemic streptococcal infection and is treated with antibiotics. recurrence usually occurs within a short interval following the initial event and is considered part of RF. OBJECTIVE: To evaluate the rate, nature, and course of recurrent SC during an extended follow-up period. DESIGN: Prospective assessment of a cohort of patients with SC who were admitted between 1985 and 2002. SETTING: General community hospital. methods: diagnosis of RF was based on the revised Jones criteria. Other causes of chorea were excluded. recurrence was defined as the development of new signs, lasting more than 24 hours and separated by a minimum of 2 months from the previous episode. patients were observed from 1 to 14 years following the initial SC episode and for at least 1 year after recurrence. At recurrence, patients were assessed for RF clinical and laboratory activity, including change in cardiac involvement. RESULTS: Twenty-four patients had SC. In 19 patients (79%), the chorea was associated with other RF signs, and 5 suffered from pure chorea. Ten patients (42%, 7 women) developed 11 recurrent episodes of chorea 3 months to 10 years after the initial episode. association of recurrent chorea with RF could be suspected in only 6 episodes: cessation of prophylactic antibiotic treatment or poor compliance in 4 patients and rise in antistreptolysin O titers in 2. In an 18-year-old woman, chorea recurred during her first pregnancy. At recurrence, chorea was the sole rheumatic sign in all 9 patients who had 1 recurrent episode. In the patient with 2 recurrent episodes, mitral regurgitation developed into mitral stenosis. No statistical differences in previous RF activity and rheumatic cardiac involvement between patients with recurrent SC and patients with a single episode could be found. CONCLUSIONS: In a significant subgroup of patients, SC recurrence might not be a true relapse of rheumatic fever. It might represent either a primary underlying abnormality that renders patients susceptible to developing such a movement disorder or the outcome of permanent subclinical damage to the basal ganglia following the initial SC episode.- - - - - - - - - - ranking = 2keywords = fever (Clic here for more details about this article) |
20/100. Corticosteroid treatment in patients with Sydenham's chorea.Sydenham's chorea occurs in approximately 10% of acute rheumatic fever and is one of its major manifestations. The disease may last for weeks or months, with a high risk of recurrence; usually only supportive treatment is recommended. This report describes five children diagnosed with Sydenham's chorea and treated with a short course of corticosteroids. Marked improvement of the involuntary movements was observed within 24-48 hours, with complete resolution within 7-12 days after commencement of treatment; there were no relapses. Larger, possibly comparative studies are necessary, but in the meantime treatment with corticosteroids in patients with Sydenham's chorea should be considered.- - - - - - - - - - ranking = 1keywords = fever (Clic here for more details about this article) |
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