Rheumatic Fever and Rheumatic Heart Diease

Question 1

Rheumatic fever; Definition

Answer 1

Rheumatic fever (RF) is a systemic, post-streptococcal, non-suppurative inflammatory disease, principally affecting the heart, joints, central nervous system, skin and subcutaneous tissues. The chronic stage of RF involves all the layers of the heart (pancarditis) causing major cardiac sequelae referred to as rheumatic heart disease (RHD).

Rheumatic fever is an acute immunologically mediated multisystem inflammatory disease that occurs few weeks after an attack of group A b- hemolytic streptococcal pharyngitis. It is not an infective disease. The most commonly affected age group is children between the ages of 5-15 yearsQ. Only 3%Q of patients with group A streptococcal pharyngitis develop acute rheumatic fever.

The disease is a type II hypersensitivity reaction in which antibodies against ‘M’ protein of some streptococcal strains (1, 3, 5, 6, and 18) cross-react with the glycoprotein antigens in the heart, joints and other tissues (molecular mimicry).

Question 2

William Boyde

Answer 2

‘rheumatism licks the joint, but bites the whole heart’.

Question 3

RF & RHD; incidence.

Answer 3

The disease appears most commonly in children between the age of 5 to 15 years when the streptococcal infection is most frequent and intense. Both the sexes are affected equally, though some investigators have noted a slight female preponderance.

Question 4

RF and RHD; major manifestations.

Answer 4

JO-Joint Movement(Polyarthritis)

O-Nodules(Subcutaneous)

E-Erythema Marginatum

S-Syndenham’s Chorea

Critera-Carditis

Question 5

Most commonly affected valve is ______ and the least commonly affected is _________.

Answer 5

mitral valve

pulmonary valve

Question 6

The plump macrophages called ________ are pathognomonic for rheumatic fever.

Answer 6

Anitschkow cells