Rheumatic Fever in Emergency Medicine Treatment & Management

  • Author: Steven J Parrillo, DO, FACOEP, FACEP; Chief Editor: Robert E O'Connor, MD, MPH   more...
 
Updated: Mar 22, 2012
 

Prehospital Care

Although no specific prehospital interventions exist for those with acute rheumatic fever, the patient's presentation may warrant establishment of intravenous access and placement of a cardiac monitor.

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Emergency Department Care

The emergency medicine physician's primary responsibilities are to suspect the diagnosis and to treat complications.

Consider early administration of antibiotics.

Acute rheumatic fever (ARF) is usually preventable if antibiotics are initiated within 9 days of the onset of streptococcal infection. Remember, however, that most patients are not susceptible to develop ARF, even when infected with GABHS. The Infectious Disease Society of America and the American Heart Association recommend that the diagnosis of GABHS infection be confirmed. In children and adolescents, a negative rapid antigen test (streptococcal screen) result should be followed by culture unless the physician has determined that in his or her own practice the rapid antigen test is comparable to a throat culture. Because of the low incidence of ARF in adults, a negative, properly performed rapid antigen test is considered acceptable evidence that streptococcal infection is not present. Note that the Center for Disease Control and Prevention (CDC) believes that the Centor Criteria can be used in most cases to rule streptococcal pharyngitis in or out and that streptococcal testing is rarely needed.

The best approach to treating the patient with pharyngitis is beyond the scope of this discussion. However, the number needed to treat to prevent one case of ARF is estimated to be 100.

The controversy regarding the need to treat all cases of streptococcal pharyngitis is acknowledged. However, it remains true that appropriate treatment of such infection can and does prevent acute rheumatic fever.[28, 29]

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Consultations

Because of the many clinical features of acute rheumatic fever (ARF), consider consulting a cardiologist, a rheumatologist, and a neurologist.

  • Carditis is not only a major clinical finding, but it also is the cause of much of the disability.
  • Arthritis is one of the major manifestations.
  • Movement disorders associated with acute rheumatic fever may be difficult to differentiate from those of other clinical problems.
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Contributor Information and Disclosures
Author

Steven J Parrillo, DO, FACOEP, FACEP  Associate Professor, Emergency Medicine, Jefferson Medical College and Philadelphia College of Osteopathic Medicine; Medical Director, Department of Emergency Medicine, Einstein Elkins Park Hospital and Roxborough Memorial Hospital; Chair, Emergency Management Committee, Albert Einstein Healthcare Network; Adjunct Professor, School of Health and Science, Philadelphia University; Medical Director and Faculty, Disaster Medicine and Management Masters Program, Philadelphia University

Steven J Parrillo, DO, FACOEP, FACEP is a member of the following medical societies: American College of Emergency Physicians, American College of Osteopathic Emergency Physicians, American Osteopathic Association, Society for Academic Emergency Medicine, and World Association for Disaster and Emergency Medicine

Disclosure: Nothing to disclose.

Coauthor(s)

Catherine V Parrillo, DO, FACOP, FAAP  Retired Clinical Assistant Professor, Department of Pediatrics, Philadelphia College of Osteopathic Medicine

Catherine V Parrillo, DO, FACOP, FAAP is a member of the following medical societies: American Academy of Pediatrics, American College of Osteopathic Pediatricians, and American Osteopathic Association

Disclosure: Nothing to disclose.

Specialty Editor Board

Assaad J Sayah, MD  Chief, Department of Emergency Medicine, Cambridge Health Alliance

Assaad J Sayah, MD is a member of the following medical societies: National Association of EMS Physicians

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Gino A Farina, MD, FACEP, FAAEM  Associate Professor of Clinical Emergency Medicine, Albert Einstein College of Medicine; Program Director, Department of Emergency Medicine, Long Island Jewish Medical Center

Gino A Farina, MD, FACEP, FAAEM is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

John D Halamka, MD, MS  Associate Professor of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center; Chief Information Officer, CareGroup Healthcare System and Harvard Medical School; Attending Physician, Division of Emergency Medicine, Beth Israel Deaconess Medical Center

John D Halamka, MD, MS is a member of the following medical societies: American College of Emergency Physicians, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Chief Editor

Robert E O'Connor, MD, MPH  Professor and Chair, Department of Emergency Medicine, University of Virginia Health System

Robert E O'Connor, MD, MPH is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, American College of Physician Executives, American Heart Association, American Medical Association, Medical Society of Delaware, National Association of EMS Physicians, Society for Academic Emergency Medicine, and Wilderness Medical Society

Disclosure: Nothing to disclose.

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