Rheumatic fever

Dr Henry Knipe and A.Prof Frank Gaillard et al.

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.  

Pathology

It principally involves the heart (pancarditis can result), joints (see article: Jaccoud arthropathy), central nervous system, skin, and subcutaneous tissue. 

Diagnosis
Jones criteria

Evidence of group A beta haemolytic streptococcus infection and 2 major or 1 major and 2 minor criterias.

  • major criteria
    • migratory polyarthritis
    • pancarditis
    • Sydenham's chorea
    • erythema marginatum
    • subcutaneous nodules
  • minor criteria
    • fever
    • arthralgia
    • increase in acute phase reactants (e.g. CRP/ESR)
    • previous episode of rheumatic fever or inactive heart disease
    • leukocytosis
    • ECG changes such as a prolonged PR interval (not if carditis is present as a major symptom)

Histology

  • Aschoff bodies
  • lymphocytes
  • 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. 

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Article information

rID: 1982
Systems: Chest, Vascular
Section: Pathology
Synonyms or Alternate Spellings:

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