Rheumatic fever - RAA - Diagnosis

Laboratory studies.
Antistreptococcal antibody detection tests:-Indicates acute infection than carriers of streptococci-Antibodies are detected: antistreptolizina O (ASO), antiADNaza strep-B (ADB), antihialuronidaza (AH), antistreptokinaza, antiesteraza, anti-NAD-Are especially useful in patients with and without other specific signs choree-Tests for the detection of antibodies to bacterial cell components include: anti-polizaharidaze, anti-teichoic acid, anti-M proteinExtracelulali-antibodies increase during the first month after infection and maintain the set back to normal after 3-6 months 6-12 months.
Bacterial culture from pharyngeal exudate:-Sensitivity is 25-40%Strep throat symptoms, during and some common rheumatic fever is negative.
Antigen detection tests have lower sensitivity. A positive result confirms the diagnosis.
Heart reactive antibodies: tropomyosin is increased in acute articular rheumatism.
Acute phase reactants:C-reactive protein and ESR are elevated-Both tests have high sensitivity but low specificity.
Other tests show:-Anemia normochromic, normocytic-Fibrigenemie> 500 mg / dL-9-moderate leukocytosis. 000-10. 000/mm3Hyper-alpha-globulinemie.
Electrocardiography highlights:Sinus-tachycardiaDegree atrioventricular block with prolonged PR intervalDegree atrioventricular block II and III, which shall be submitted along with the progressionOccur in acute pericarditis-ST elevation in leads II, III, aVF and V4-V6-Patients with left atrial dilatation may develop atrial fibrillation, atrial flutter, multifocal atrial tachycardia.
Imaging studies.
Chest radiograph reveals cardiomegaly, pulmonary congestion and other elements characteristic of heart failure.
Echocardiography to identify valvular insufficiency and ventricular dysfunction. Doppler study allows achieving certification valvular regurgitation flow by revealing clinically undetectable, structural alterations of valve-view nodes, but excluding other causes of regurgitation. Also allows quantification of myocardial contractility and pericardial fluid detected.
The differential diagnosis is made with: bicuspid aortic valve, mitral valve prolapse, other causes of valvulopathy, dilated cardiomyopathy, carditis viral, bacterial, sarcoidosis, Takayasu arteritis, Kawasaki disease, septic arthritis, rheumatoid arthritis, reactive, erytema nodosum, SLE, spondylitis spondilartrita .