Rheumatic fever is an acute

immunologically mediated , multisystem inflammatory disease that occurs a few weeks following an episode of group A streptococcal pharyngitis .

 Poverty, poor hygiene , overcrowded Age 5 15 yrs.

10 days 6 weeks after GAS

infection. Affects 3 % of patients. 20 % in adults. Recurrent attacks cause cumulative damage .

 Hypersensitivity response

induced by groupA B hemolytic streptococcus. Antibodies to M porotein od the bacteria cross react with the glycoproteins in the joints heart and other tissues.

Develops 10 days to 6 weeks after pharyngitis

1. Migratory polyarthritis
2. Carditis

3. Subcutaneous nodule
4. Erythema marginatum

5. Sydenham chorea

After initial attack , recurrent

episodes with same c/f Cumulative damage mainly affecting the heart. RHD manifests yrs or decades later.

Valvular heart disease

Mitral stenosis,
MR AS AR Atrial fibrillation

Cardiac failure

 acute phase proteins ESR

Antiobody detection:
ASO titer , antiDNAse B.

Throat culture
Imaging

ECG prolonged PR interval.

Echo

 2 major or 1 major & 2 minor

 Enlarged heart
Pancarditis Endocarditis: Valvular vegetations verrucae Maccallum plaques in left atrium Myocarditis: Aschoff bodies in myocardium
Anitschkow cells or caterpillar cells

Pericarditis:
Pericardial effusion Serofibrinous exudates bread and butter

pericarditis.

Valve deformity in chronic RHD.

Aschoff giant cell

Anitschkow cells or caterpillar cells

 Embolic episodes Infective endocarditis Pericardial effusion Valvular defect with cardiac

hypertrophy Cardiac failure Atrial fibrillation Rheumatic pneumonitis

INFECTIVE INFECTIVE ENDOCARDITIS.

NONINFECTIVE RHEUMATIC CARDITIS. NONBACTERIAL THROMBOTIC ENDOCARDITIS. LIBMAN SACKS DISEASE. ( SLE )

ACUTE DAYS WEEKS VIRULENT ORGANISM NORMAL HEART

SUBACUTE WEEKS MONTHS

LOW VIRULENT ORGANISM ABNORMAL VALVES VALVULAR LESS DESTRUCTION DESTRUCTIVE POOR PROGNOSIS BETTER PROGNOSIS

BACTERIA. FUNGAL.

RICKETTSIA.
CHLAMYDIAE.

STAPH AUREUS. STREP VIRIDANS. STAPH EPIDERMIDIS. GRAM VE BACILLI. ENTEROCOCCI.

HACEK GROUP HAEMOPHILUS. ACTINOBACILLUS. CARDIOBACTERIUM. EIKENELLA. KINGELLA.

RHEUMATIC HEART DISEASE. CONGENITAL HEART DISEASE. MVP. PROSTHETIC VALVES. DENTAL,SURGICAL, MEDICAL PROCEDURES.

IV DRUG ABUSE. IMMUNODEFICIENCY. IMMUNOSUPRESSION. ALCOHOL. DIABETES MELLITUS.

ORAL COMMENSALS. - STREP VIRIDANS. - HACEK. DAMAGED VALVES.

2 3 % GET INFECTED. STAPHYLOCOCCUS EPIDERMIDIS . ( 50-60 % ) POSTOP FEVER.

STAPH AUREUS. CANDIDA. RIGHT SIDE HEART.

 Vegetations-friable, bulky &

distructive AV, MV (right side) Ring abscess( abscess in myocardium)

 Granulation tissue, fibrosis

calcification and chr infla cells.

 FEVER.

CHILLS.
LOSS OF WEIGHT.

MURMURS.

PETECHIAE.
SPLINTER HGE. JANEWAY LESIONS.

OSLER NODES.
ROTH SPOTS. CLUBBING.

 ERYTHEMATOUS

OR HEMORRHAGIC NONTENDER, RAISED LESIONS ON PALMS & SOLES. IMMUNOLOGIC.

 TENDER , RED ,

SUBCUTANEOUS NODULES IN PULP OF DIGITS.

 OVAL

HEMORRHAGES WITH PALE CENTRES.

VALVE DAMAGE. RING ABSCESS. PERICARDITIS. MYOCARDITIS. DEHISCENCE OF PROSTHETIC VALVES. CONDUCTION DEFECTS.

EMBOLIC. IMMUNOLOGIC. -GLOMERULO NEPHITIS.

BLOOD CULTURE & SENSITIVITY.

ECHOCARDIOGRAM.
ECG. X RAY CHEST.

 MINIMUM OF 3 SETS

OF SAMPLES COLLECTED FROM DIFFERENT VENEPUNCTURE SITES AT 15 30 MIN INTERVALS FOR 1-2 HRS.

MAJOR. 1) POSITIVE BLOOD CULTURE FOR CHARACTERISTIC ORGANISM.

2)

MASS OR ABSCESS IN ECHO.

3) NEW VALVULAR REGURGITATION.

1) 2)

3)

4)
5) 6)

PREDISPOSING HEART LESIONS / INTRAVENOUS DRUG ABUSE. FEVER. VASCULAR LESIONS PETECHIAE, SPLINTER HGE, JANEWAY LESION, EMBOLIC LESIONS. IMMUNOLOGIC - GLOMERULONEPHITIS, OSLER NODES, ROTH SPOTS. CULTURE NONCHARACTERISTIC . ECHO CONSISTENT BUT NOT DIAGNOSTIC.

 2 MAJOR.

OR 1 MAJOR + 3 MINOR. OR 5 MINOR.

ANTIBIOTICS . SURGICAL. ANTIBIOTIC PROPHYLAXIS IN PATIENTS WITH CARDIAC DEFECTS DURING PROCEDURES.

DEPOSITION OF STERILE THROMBUS ON VALVES.

 CANCERS ( MUCIN SECRETING).

AML M3.
DIC. HYPERESTROGENIC STATES.

SEPSIS.

( SLE )

 LESIONS SEEN ON BOTH SIDES OF VALVES.

PANCARDITIS COMMON. DAMAGE TO VALVES OCCURS.