4th Pediatric Infectious Diseases Conference
 
 
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Rheumatic Heart disease
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Specialist Answers
Question
We have one patient 7 year old male with history of fever on and off since 2 month (undocumented) no other chief complaints, on examination pulse rate 134, rr- 18 , bp 110/68, cvs - diastolic murmur grade 3, p/a no organomegaly , chest is clear ..investigation revealed ESR 15, CRP 19, ECG normal , ASO 200, CXR no cardiomegaly with mild pulmonary plethora, Echo s/o MR. Now patient is with us for 48 hour and there no fever, there is no history s/o old RF or other manifestation of RF. How should we managed this patient? Is steroid indicted as ESR and crp increased. Are these are sufficient evidence for activity?
Answer
What is the ASO titre? Also do ECG to look for PR interval. The child if has positive ASO may fit into Jones criteria. However, Insidious onset or late onset carditis is a situation where Situations where Jones criteria need not be satisfied to make a diagnosis of RF/ RHD.
Also rule out SLE, Do ANA and dsDNA.
If diagnosed as Rheumatic Heart disease, aspirin may be needed. Steroids are not indicated as there is no cardiomegaly or cardiac failure.
 
 
 
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