4- rheumatic fever + endocarditis

streptococcal/bacterial pharyngitis (strep throat) is caused by which bacteria

Group A β-hemolytic streptococcus aka S. pyogenes, found in normal oral flora

what’s the incubation period of group A strep pharyngitis

2-5 days

streptococcal/bacterial pharyngitis (strep throat) symptoms

• dysphagia (difficulty swallowing)

• odynophagia (painful swallowing)

• swollen + painful anterior cervical lymph nodes

• tonsillar exudates

water eyes + runny nose occur within bacterial or viral pharyngitis

viral

β-hemolytic streptococcus infection can also cause what

scarlet fever

2 ways to diagnose streptococcal pharyngitis

1. rapid antigen detection test

2. throat culture: gold standard

recommended rx for group A streptococcal pharyngitis pts w/ penicilllin allergy

clindamycin 7 mg 3x/day for 10 days

2 non-suppurative (no discharge) complications after group A strep infections

1. acute rheumatic fever (ARF)

2. Post-streptococcal glomerulonephritis

T/F: complications after group A strep infections only occur after original infection resolves

true

what’s acute rheumatic fever (ARF)

acute inflammatory response to past untreated/partially treated group A β-hemolytic streptococcus infection, affecting peri-arteriolar connective tissue

age group most affected by acute rheumatic fever (ARF)

5-15 years

5 major criteria of acute rheumatic fever (ARF)

1. erythema marginatum (rare)

2. carditis

3. skin nodules

4. sydenham chorea

5. migratory polyarthritis

E C S S M

6 minor criteria of acute rheumatic fever (ARF)

1. fever

2. pain in the R upper abdominal quadrant (RUQ)

3. elevated Erythrocyte Sedimentation Rate (ESR)

4. increased C-reactive protein (CRP)

5. antibody titer tests: ASO, antistreptococcal DNAse B (ADB), streptozyme

6. EKG + Doppler echocardiography as tools to diagnose cardiac involvement

for acute rheumatic fever (ARF) diagnosis, pt must have

• 2 major criteria

• 1 major + 2 minor

for recurrent acute rheumatic fever (ARF) diagnosis, pt must have

• 2 major

• 1 major + 2 minor

• 3 minor

rheumatic arthritis commonly occurs in

children

rheumatic arthritis is referred as a

fleeting type of arthritis

rheumatic heart disease (RHD)/carditis affects which layers of the heart

all 3 layers can be affected

which layer of the heart is most frequently involved in rheumatic heart disease (RHD)/carditis

endocardium (innermost)

which layer of the heart is least frequently involved in rheumatic heart disease (RHD)/carditis

myocardium

premed needed or not needed for ARF pts w/ or w/o RHD

not needed

T/F: subcutaneus nodules (erythema nodosum) is not specific to ARF

true

subcutaneus nodules (erythema nodosum) indicates which disease

ARF+ TB + sarcoidosis

what does the anti-streptolysin O titer (ASO) test for

if group A strep infection has caused a post-strep disease like scarlet fever, ARF or glomerulonephritis

anti-Dnase-B (ADB) tests for

determines presence of a past group A beta-hemolytic Strep. infection

which of the lab tests in the minor criteria of acute rheumatic fever (ARF) detect 95% of past strep infections

when anti-streptolysin O titer (ASO) + anti-Dnase-B (ADB) are done together, not alone

streptozyme test tests for

quickly detects all antibodies in a single assay but does not specify which ones

what’s the primary prevention therapy for acute rheumatic fever (ARF)

same Rx for treating group A strep pharyngitis

treatment of acute rheumatic fever (ARF) has what 2 phases

1. acute phase tx

2. secondary prevention prophylaxis tx

what’s the Rx for secondary prevention prophylaxis tx of acute rheumatic fever (ARF) pts w/ no allergies

• benzathine benzyl penicillin G

• penicillin VK

what’s the Rx for secondary prevention prophylaxis tx of acute rheumatic fever (ARF) pts w/ penicillin allergy

sulfonamide (suldadiazine)

what’s the Rx for secondary prevention prophylaxis tx of acute rheumatic fever (ARF) pts w/ penicillin + sulfonamide allergy

• erythryomycin

• azithromycin

how should you space out a premed during secondary prevention prophylaxis tx of acute rheumatic fever (ARF)

6 hrs between the 2 meds

what causes bacterial endocarditis

invasive tx → bacteremia → septic vegetation at endothelial trauma site → septic thrombus dislodges into circulation

what are the 2 types of bacterial endocarditis

1. acute bacterial endocarditis (ABE)

2. subacute bacterial endocarditis (SBE)

which type of bacterial endocarditis is more common

subacute bacterial endocarditis (SBE)

what causes acute bacterial endocarditis (ABE)

1. staphylococcus

2. viral

3. fungal

what causes subacute bacterial endocarditis (SBE)

α-hemolytic streptococcus

which type of bacterial endocarditis has no specific age/population prevalence

subacute bacterial endocarditis (SBE)

how is infective endocarditis (IE) treated

pt hospitalized ASAP to treat systemic infection & associated vital organ involvements

after recovering from endocarditis, the pt will always need ____ for the rest of their life

premed antibiotic prophylaxis prior to any invasive dental tx

premed prophylaxis is recommended against which bacteria

α-hemolytic streptococcus

which 4 underlying conditions are premed prophylaxis required for

1. prosthetic cardiac valve/material

2. previous, relapse, recurrent infective endocarditis (IE)

3. congenital heart disease

4. cardiac transplant recipients who develop cardiac valvulopathy

when should a pt take their premed antibiotics prophy

single dose 30-60 min before tx

which antibiotic is no longer recommended for premed prophylaxis

clindamycin

which antibiotic should not be used for premed prophy in a pt w/ history of anaphylaxis, angioedema, or urticarial w/ pecillin or ampicillin

cephalosporins

pts w/ bio-prosthetic valves require uninterrupted blood thinning w/ ____ in 1st ____ months

coumadin (warfarin), 3-6 months

which meds do you take for premed prophy if you can’t take oral meds

1. ampicillin

2. cefazolin

3. ceftriaxone

which meds do you take for premed prophy if you’re allergic to pencillin or ampicillin

1. cephalexin

2. azithromycin

3. clarithromycin

4. doxycycline

which meds do you take for premed prophy if you’re allergic to pencillin/ampicillin + you can’t take meds orally

1. cefazolin

2. ceftriaxone

what type of dental procedures do you need to premed for

anything that involves manipulation of gingival tissue, periapical region of teeth, perforation of oral mucosa