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Rheumatic Fever

Rheumatic Fever

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Published by: princessisma on Jul 09, 2014
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Rheumatic fever
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Rheumatic fever
Classification & external resources
390 – 392
Rheumatic fever
 is an in&'ammator( !isease )hich ma( !eve'op a&ter a *roup + streptococca' in&ection such as strep throat or scar'et &ever  an! can invo've the heart,  oints, s/in, an!  rain.
%edit& 'eneral information
heumatic &ever is common )or'!)i!e an! responsi'e &or man( cases o& !amage! heartva'ves. In the <estern countries, it ecame &air'( rare since the 19$0s, proa'( !ue to )i!esprea! use o& antiiotics to treat streptococcus in&ections. <hi'e it is &ar 'ess
common in the =nite! >tates since the eginning o& the 20th centur(, there have een a &e) outrea/s since the 1980s. +'though the !isease se'!om occurs, it is serious an! has amorta'it( o& 2–#?.heumatic &ever primari'( a&&ects chi'!ren et)een ages $ an! 1# (ears an! occurs appro;imate'( 20 !a(s a&ter strep throat or scar'et &ever. In up to a thir! o& cases, the un!er'(ing strep in&ection ma( not have cause! an( s(mptoms.6he rate o& !eve'opment o& rheumatic &ever in in!ivi!ua's )ith untreate! strep in&ection is estimate! to e 3?. 6he rate o& !eve'opment is &ar 'o)er in in!ivi!ua's )ho have receive! antiiotic treatment. 5ersons )ho have su&&ere! a case o& rheumatic &ever have aten!enc( to !eve'op &'are-ups )ith repeate! strep in&ections.6he recurrence o& rheumatic &ever is re'ative'( common in the asence o& maintenance o& 'o) !ose antiiotics, especia''( !uring the &irst three to &ive (ears a&ter the &irst episo!e. 7eart comp'ications ma( e 'ong-term an! severe, particu'ar'( i& va'ves are invo've!.
%edit& Dia(nosis) modified *ones criteria
6. %uc/ett Jones, %, &irst pu'ishe! these criteria in 1944.
 6he( have een  perio!ica''( revise! ( the +merican 7eart +ssociation in co''aoration )ith other groups.
+o maor criteria, or one maor and to minor criteria
, )hen there is a'so evi!ence o& a previous strep in&ection, support the !iagnosis o& rheumatic &ever .
%edit& !aor criteria
 in&'ammation o& the heart musc'e )hich can mani&est as congestive heart &ai'ure )ith shortness o& reath,  pericar!itis )ith a ru, or a ne) heart murmur .
 a temporar( migrating in&'ammation o& the 'arge oints,usua''( starting in the 'egs an! migrating up)ar!s.
#ydenham.s chorea /#t itus. dance2)
 a characteristic series o& rapi! movements )ithout purpose o& the &ace an! arms. 6his can occur ver( 'ate in the !isease.
 a 'ong 'asting rash that egins on the trun/ or arms as macu'es an! sprea! out)ar! to &orm a sna/e'i/e ring )hi'e c'earing in the mi!!'e.6his rash never starts on the &ace an! is ma!e )orse )ith heat.
#u4cutaneous nodules /a form of 5schoff 4odies2)
 pain'ess, &irm co''ections o& co''agen &iers on the ac/ o& the )rist, the outsi!e e'o), an! the &ront o& the /nees. 6hese no) occur in&re@uent'(.
%edit& !inor criteria
: temperature e'evation
 Joint pain )ithout s)e''ing
6a4oratory a4normalities)
 anorma'ities: a pro'onge! 5 interva'
3vidence of 'roup 5 #trep infection)
 positive cu'ture &or *roup + >trep, e'evate! or rising +ntistrepto'(sin  titre
"revious rheumatic fever or inactive heart disease
%edit& 7ther si(ns and symptoms
%edit& "athophysiolo(y
heumatic &ever is a s(stemic !isease a&&ecting the peri-arterio'ar connective tissue an! can occur a&ter an untreate! *roup + streptococca' phar(ngea' in&ection. It is e'ieve! to  e cause! ( antio!( cross-reactivit(. 6his cross-reactivit( is a 6(pe II h(persensitivit( reaction an! is terme!
molecular mimicry.
 =sua''(, se'& reactive B ce''s remain anergic inthe peripher( )ithout 6 ce'' co-stimu'ation. %uring a >trep. in&ection activate! antigen  presenting ce''s such as macrophages present the acteria' antigen to he'per 6 ce''s. 7e'per 6 ce''s suse@uent'( activate B ce''s an! in!uce the pro!uction o& antio!ies against the ce'' )a'' o& >treptococcus. 7o)ever the antio!ies ma( a'so react against the m(ocar!ium an! oints
, pro!ucing the s(mptoms o& heumatic &ever.*roup +
 has a ce'' )a'' compose! o& ranche!  po'(mers )hich sometimes contain C
 M proteins
C that are high'( antigenic. 6he antio!ies the immune s(stem generates against the C
 M proteins
C ma( cross react )ith car!iac m(o&ier sarco'emma an! smooth musc'e ce''s o& arteries, in!ucing c(to/ine re'ease an! tissue !estruction. 6his in&'ammation occurs through !irect attachment o& comp'ement an! Dc receptor-me!iate! recruitment o& neutrophi's an! macrophages. Aharacteristic +scho&&  o!ies, compose! o& s)o''en eosinophi'ic co''agen surroun!e! ( '(mphoc(tes an! macrophages can e seen on 'ight microscop(. 6he 'arger macrophages ma( ecome +scho&& giant ce''s. +cute rheumatic va'vu'ar 'esions ma( a'so invo've a ce''-me!iate! immunit( reaction as these 'esions pre!ominant'( contain 6-he'per  ce''s an! macrophages.
In acute D, these 'esions can e &oun! in an( 'a(er o& the heart an! is hence ca''e!  pancar!itis. 6he in&'ammation ma( cause a sero&irinous pericar!ia' e;u!ates !escrie! as Erea!-an!-utterF pericar!itis, )hich usua''( reso'ves )ithout se@ue'ae. Invo'vement o& the en!ocar!ium t(pica''( resu'ts in &irinoi! necrosis an! verrucae &ormation a'ong the 'ines o& c'osure o& the 'e&t-si!e! heart va'ves. <art( proections arise &rom the !eposition, )hi'e suen!othe'ia' 'esions ma( in!uce irregu'ar thic/enings ca''e! acAa''um p'a@ues.Ahronic rheumatic heart !isease is characteriGe! ( repeate! in&'ammation )ith &irinousreso'ution. 6he car!ina' anatomic changes o& the va've inc'u!e 'ea&'et thic/ening,

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