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Rheumatic Fever

Rheumatic fever is an immune-mediated disease that occurs 2-3 weeks after infection by group A β-hemolytic streptococci, leading to various tissue reactions including fibrinoid degeneration and the formation of Aschoff's nodules. It primarily affects the heart, joints, and skin, with major criteria for diagnosis including migratory polyarthritis, carditis, and subcutaneous nodules. Diagnosis requires at least two major or one major and two minor criteria, with severe myocarditis potentially leading to death.

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11 views3 pages

Rheumatic Fever

Rheumatic fever is an immune-mediated disease that occurs 2-3 weeks after infection by group A β-hemolytic streptococci, leading to various tissue reactions including fibrinoid degeneration and the formation of Aschoff's nodules. It primarily affects the heart, joints, and skin, with major criteria for diagnosis including migratory polyarthritis, carditis, and subcutaneous nodules. Diagnosis requires at least two major or one major and two minor criteria, with severe myocarditis potentially leading to death.

Uploaded by

alisaad50150
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© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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Rheumatic Fever

Rheumatic fever is an immune-mediated disease(✓) , isn't an Auto-immune disease


(✕)
occurring 2-3 wk after infection by group A β-hemolytic streptococci (GABS).

Tissue Reaction:
Exudative:
Collagen fibers undergo disintegration (fibrinoid degeneration).

° It mostly identified in serous sacs as pericardium, pleura and joint cavities.


Proliferative:
Granulomatous phase characterized by formation of Aschoff's nodules.
Healing:
The lesions undergo fibrosis .

Aschoff Nodule:
found para-vascular.
With chronicity there is a palisade of:
1. Histiocytes (Antichoff cell)
2. Multinucleated giant cells with multiple central nuclei and basophilic cytoplasm.
(Aschoff cells ).

HEART :
Acute rheumatic heart disease characterized by : Pan-carditis (myocarditis, endocarditis and
pericarditis).

- Myocarditis:

Gross picture: - Mild cardiac dilatation and softening of myocardium


Microscopic picture - Cloudy swelling and fatty degeneration of myocardial fibers.

- Pericarditis:
Sero-fibrinous (Fibrous) inflammation of the pericardium. Sero-fibrinous Dosen't equal
(Serous) (✕)

- Endocarditis :

Mural:
Inflammation and edema of mural endocardiom.
McCallum's patchs: represent Aschoff's nodules , usually seen in the posterior wall of the Lt.
Atrium

- Valvular (vegetations) :

adherent platelet and fibrin thrombi called vegetations.


N.B: Affection of pulmonary & tricuspid valves are less Common .

- JOINTS (Rheumatic Arthritis) :


Ø Affect usually large joints as the knee and ankle.
Ø Migratory ( fleeting): i.e. affecting one joint after the other.
Ø Leaves no deformity because the articular cartilage is not affected.
Ø Microscopic picture: Acute sero-fibrinous inflammation of the synovium with exudation in
the joint cavity.

- SKIN :

Subcutaneous nodules:
Ø Sites: Over bony prominences , on extensor surfaces of limbs, skull and in relation to
vertebral column.
Ø Gross picture: Circumscribed nodules about 2 cm in diameter, mobile and firm in
consistency. The overlying skin is edematous but not ulcerated .
Ø Microscopic picture: Granulomatous reaction formed of Aschoff's nodules .

Major Criteria:
J♥NES
1-Joint (migratory polyarthritis)
2- ♥(carditis)
3-Nodules in skin (subcutaneous)
4-Erythema marginatum
5-Sydenham chorea

Minor Criteria:
1- Previous attack of rheumatic fever.
2- Arthralgia.
3- Leucocytosis.
4- Elevated ESR, CRP and ASO titer.

N. B: The diagnosis of rheumatic fever requires at least 2 major John's criteria or one
major criterion with2 minor criteria.
Death from severe myocarditis.

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