High rates of impetigo are a marker for widespread streptococcal transmission. Diagnosis
Chorea is distinctive, if the health care provider is familiar with it. The diagnosis is then made by the typical acute onset in the weeks following a sore throat or other minor infection, plus evidence of inflammation (raised CRP and/or ESR) and evidence of recent streptococcal infection. To confirm recent streptococcal infection:

Throat culture
Anti-DNAse B titre (peaks at 8–12 weeks after infection)
Anti-streptolysin O titre (peaks at 3–5 weeks)None of these tests are 100% reliable, particularly when the infection was some months previously. Further testing is directed more towards alternative diagnoses and other manifestations of rheumatic fever:

Echocardiography
EEG
Lumbar puncture
Magnetic resonance imaging or computed tomography scan of the brain (alterations in caudate nucleus and putaminal enlargement have been described in some patients)

Management
Management of Sydenhams chorea is based on the following principles:

Eliminate the streptococcus – it may not be of any use for the index patient but further spread of that specific clone will be prevented. Treat the movement disorder
Immunosuppression
Prevention of relapses and further cardiac damage
Manage the disabilityThere is a UFMG rating scale for Sydenhams chorea, from Brazilian Universidade Federal de Minas Gerais (UFMG), for research purposes, but it only looks at motor function not psychiatric/behavioural symptoms. Occupational therapy and physiotherapy is useful for maintaining function and muscle tone. Treatment with sodium valproate is effective for controlling symptoms, but it doesn’t speed up recovery. Haloperidol was used previously, but caused serious side effects e.g. tardive dyskinesia.
Hematosalpinx (sometimes also hemosalpinx) is a medical condition involving bleeding into the fallopian tubes. Symptoms
A hematosalpinx from a tubal pregnancy may be associated with pelvic pain and uterine bleeding. A gynecologic ultrasound will show the hematosalpinx. A hematosalpinx from other conditions may be painless but could lead to uterine bleeding. Causes
A number of causes may account for a hematosalpinx, by far the most common being a tubal pregnancy. Blood may also escape into the peritoneal cavity leading to a hemoperitoneum. A hematosalpinx can also be associated with endometriosis or tubal carcinoma. Further, if menstrual blood flow is obstructed (cryptomenorrhea), caused for instance by a transverse vaginal septum, and gets backed up it may lead to a hematosalpinx. Diagnosis
Diagnosis may include, but is not limited to, ultrasound, magnetic resonance imaging (MRI) and laparoscopy. Treatment
Treatment is directed at the underlying condition and is usually surgical. See also
Hydrosalpinx

References


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