Rheumatic fever is a multisystemic inflammatory disorder caused by type II hypersensitivity reaction following group A beta haemolytic streptococcus pharyngeal infection. Cross reaction of antibodies against protein M with other cells glycoproteins leads to involvement of other organs such as heart.
It principally involves the heart (pancarditis can result), joints (see article: Jaccoud arthropathy), central nervous system, skin, and subcutaneous tissue.
Evidence of group A beta haemolytic streptococcus infection and 2 major or 1 major and 2 minor criterias.
- major criteria
- minor criteria
- increase in acute phase reactants (e.g. CRP/ESR)
- previous episode of rheumatic fever or inactive heart disease
- ECG changes such as a prolonged PR interval (not if carditis is present as a major symptom)
- Aschoff bodies
- swollen collagen
- plump macrophages (Anitschkow cells): pathognomonic
- Anitschkow cells can fuse to become multinucleated cells (Aschoff cells)
Treatment and prognosis
Benzathine penicillin 120 IU intramusacular injuection is the drug of choice to eliminate group A streptococci. While good supportive therapy can reduce the mortality and morbidity of the disease.
The clinical course can varies greatly, but in general, ~75% of acute rheumatic attacks subside within 6 weeks.
- 1. Kumar V. et al Robbins and Cotran Pathologic Basis of Disease, 7th edition, Elsevier Saunders 2005