Fiebre Reumática

Question 1

Qué es

Answer 1

S. pyogenes M-protein and N-acetyl glucosamine cross-react with cardiac myosin, laminin and other self antigens.

Se presenta 2-4 semanas después de la faringitis estreptococica

Question 2

Principal válvula afectada

Answer 2

Mitral regurgitation or prolapse is an early sign
Estenosis mitral is late sign (chronic)

Question 3

Anticuerpos encontrados

Answer 3

Antiestreptolisina O (ASO)
Antidesoxyrribonucleasa B (ADB)
Antiestreptoquinasa
Antihialuronidasa

Question 4

FR

Answer 4

HLA2 DR2 y DR4

Question 5

Fisiopato

Answer 5

Fase aguda:

1. Reacción cruzada mediada por linfos T CD4 y linfos B
2. Aschoff bodies: granulomas reumáticos (en el músculo de la válvula mitral)
3. Pericarditis and pericardial exudates decrease ventricular filling capacity and can cause a hearth failure.
4. Antibodies against GAS carbohydrate antigen cross-react with neuronal cells in the basal ganglia = release excess dopamine = corea manifestations
5. Joint tissue destruction = artritis/arthralgia

Chronic phase:

Mostly affects the heart
Inflammation leads to neovascularization and healing by fibrosis
Buildup of fibrotic tissue in heart valves
Stenosis of heart valves

Question 6

Tx

Answer 6

Artritis y artralgias:

Antes de confirmar el dx tratar el dolor c/paracetamol
Ya que se confirma el dx tratar artralgias severas con salicilatos, alternativa: Naproxeno

Tx de la corea severa:

Carbamazepina

Tx de la carditis:

Prednisona o prednisolona