Rhematic Fever Strep Pyogenes

Question 0

Explain pathophysiology of streptococcus pyogenes

Answer 0

Strep pyogenes –> antibody mediated disease – >

Develop Ab against strep pyogenes M prot ->

M protein similar to heart tissue antigen ->

Molecular mimicry HSR to AB damage to heart valve

Question 1

When does the first attack happen for rheumatic fever?
Explain how it progresses?
Risk factors for rheumatic fever

Answer 1

5–15 years
Strep pyogenes pharyngitis – >
20 days/1–5 wks –>
Rheumatic fever

Crowding + young age

Question 2

What are the major Jones criteria for rheumatic fever

Answer 2

Major:
Joints – polyarthritis

❤️pancarditis
-MMMMyocarditis –most CCofD @acute-phase
Aschoff bodies (granuloma+giant cells)
Anitschkow histiocytes
-EEEndocarditis
mitral >aortic – valve vegetations regurg
-PPPericarditis – friction rub + chest pain

Nodules = subcutaneous
Erythema marginatum
Sydenham chorea = rapid involuntary movements

Question 3

What are the minor Jones criteria

Answer 3

Fever PAPA

Fever
Previous rheumatic fever heart disease
Arthralgia
PPPRRRolonged PPPPR interval – 1st° heart block
Acute-Phase reactants – ⬆️ESR

Question 4

Explain how repeat exposure to strep pyogenes can damage the heart valve

Answer 4

Chronic rheumatic fever – >scarring from acute rheumatic attacks – >

Stenosis = mitral = thick chordae/cusps
Stenosis = aortic = Fusion of commissures FISH-mouth appearance