Acute Rheumatic Fever and Rheumatic Heart Disease

Question 1

Acute rheumatic fever (ARF) Etiology?

Answer 1

Antibodies formed against GAS cross-react against patient’s host antigens (molecular mimicry)

usually presents in children 5-15 years of age

Question 2

Rheumatic heart disease (RHD) Etiology?

Answer 2

Late sequelae of acute rheumatic fever;

presents 20+ years after ARF

Question 3

ARF HISTO FX?

Answer 3

Aschoff bodies (inflammatory foci surrounded by lymphocytes)

Anitschkow cells (macrophages which may become multinucleated)

Question 4

ARF GROSS FX?

Answer 4

Pancarditis in heart tissue;

Serofibrinous pericardial exudate

Question 5

RHD GROSS FX?

Answer 5

Mitral stenosis with fish-mouth deformity;

May also affect aortic valve

Question 6

ARF CLINICAL SIGNS?

Answer 6

Onset of symptoms 2-3 weeks after streptococcal pharyngitis;

Major Jones criteria include:
carditis, 
migratory polyarthritis, 
chorea, 
erythema marginatum (blanching, ring-shaped rash),
subcutaneous nodules

Minor Jones criteria:
fever,
arthralgia,

Question 7

ARF LAB FINDINGS?

Answer 7

Elevated ESR

Question 8

ARF DIAGNOSIS?

Answer 8

Revised Jones Criteria :
2 major or 1 major + 2 minor with evidence of strep infection

Evidence of previous streptococcal infection:
-positive anti–streptolysin O [ASO] titer

Question 9

RHD CLINICAL SIGNS?

Answer 9

valvular heart disease = usually mitral stenosis

may have aortic stenosis

Question 10

RHD complications?

Answer 10

hypertrophy of heart,

arrhythmias

heart failure

Question 11

ARF AND RHD TREATMENT?

Answer 11

Penicillin for streptococcal infection;

salicylates for fever and arthritis;

endocarditis prophylaxis if indicated

Question 12

ARF epid?

Answer 12

leading cause of childhood heart disease

Question 13

Acute rheumatic fever associated with which subtypes of GAS ?

Answer 13

M types 5, 14, 18, 24

Question 14

Acute glomerulonephritis onset?

Answer 14

2-3 weeks after streptococcal infection

nephritogenic M types

Question 15

Acute glomerulonephritis outcome?

Answer 15

acute renal failure

Question 16

Acute glomerulonephritis due to GAS diagnosis?

Answer 16

ASO serodiagnosis unreliable for AGN