Rheumatic Fever
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Introduction
Rheumatic fever (RF) is an acute, multisystem inflammatory disease occurring a few weeks after an episode of group A streptococcal pharyngitis.
RF can involve the joints, heart, skin, and nervous system. Acute disease can extend to chronic symptoms.
The Case of...
Causes and Risk Factors
Incidence and mortality have decreases dramatically over the past decades, owing to improved socioeconomic conditions, rapid diagnosis and treatment, and an unexplained decrease in virulence. However, in developing countries, and in low-income urban areas of the West, rheumatic fever remains an important public health concern.
- involves inflammatory changes to heart, vasculature, joints, and subcutaneous tissues
- can lead to valvular scarring (ie mitral stenosis) and eventual heart failure
- M protein is considered rheumatogenic due to its antigenic similarity to cardiac epitopes
- erysipelas
- acute infection of skin, raised and distinctly differentiated from uninvolved tissue; systemic symptoms
Pathophysiology
It is strongly suspected pharyhgitis induces a hypersensitivity reaction. Cross reactivity with the M proteins of certain bacteria and glycoproteins of the heart, joints, and other tissues appears to occur.
Signs and Symptoms
Diagnosis is often made using the Jones criteria:
major criteria
- subcutaneous nodules
- carditis
- polyarthritis
- chorea
- erythema marginatum
minor criteria
- history
- physical exam
History
Migratory polyarthritis of the large joints, carditis, subcutaneous nodules, erythema marginatum of the skin, and Sydenham chorea.
Physical Exam
Investigations
- lab investigations
- diagnostic imaging
Lab Investigations
Diagnostic Imaging
Differential Diagnosis
Treatments
Consequences and Course
Acute rheumatic carditis can be followed by chronic disease.
Resources and References
Topic Development
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