Review Question - QID 101648

Early treatment of Group A Streptococcal pharyngitis with penicillin reduces the risk of developing rheumatic fever. Mitral stenosis is a classic long-term sequela of rheumatic fever, often manifesting decades after the initial insult, and presenting with a diastolic murmur with an opening snap.

In patients that have already suffered an attack of rheumatic fever, prophylaxis with penicillin prevents subsequent recurrent episodes of rheumatic fever, reducing the risk of long-term cardiac manifestations. Cardiac manifestations of acute rheumatic fever stem from cross-reactivity of antibodies against the M protein of group A Streptococci with the heart valve tissue.

Alto and Gibson review the clinical management of acute rheumatic fever and find that penicillin remains the preferred prophylactic agent for secondary prevention of subsequent development of rheumatic fever after Group A Strep infection as well as an initial episode of rheumatic fever. Salicylates are also useful in the treatment of arthritis associated with rheumatic fever.

Marijon et al. explore the pathophysiology and management of rheumatic heart disease. They state the an abnormal autoimmune response to group A strep in a genetically susceptible host is responsible for the development of acute rheumatic fever, which can affect the joints, heart, and brain and can lead to irreversible valve damage and heart failure.

Incorrect Answers:
Answer 1: Acyclovir is an anti-viral medication and would not be effective in the setting of this bacterial-mediated illness.
Answer 3: Vancomycin may be used to treat patients with rheumatic fever who are allergic to penicillin. However, prolonged low-dose penicillin remains the first-line treatment.
Answer 4: Aspirin would not prevent the development of rheumatic fever, but can be used for treatment of arthritis associated with rheumatic fever.
Answer 5: Ciprofloxacin is not recommended as first-line prophylaxis for streptococcal pharyngitis and rheumatic fever.