Rheumatic fever Flashcards
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Age group
in children and young adults (5- 15 years)
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MOs
Group A beta hemolytic strep pyogenes
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Strep pyogenes can cause
Skin infection
Pharyngitis
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Rheumatic fever occurs after
pharyngitis
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Type of immune reaction seen in RF
Type 2 auto immune
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Type 2 Autoimmune reaction
Mediated by Ab. Body produces Ab againts the M protein on MOs. The body itself has proteins similar to M protein. So the Ab will attack the body’s Proteins ( Molecular mimicry)
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Type I Autoimmune reaction
- IgE mediated mast cells.
- histamine
- eg- anaphylaxis
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Type 3 Autoimmune reaction
mediated by Ag- Ab complex. this complex will deposit on cells and activate compliments. This causes the reaction
* Eg- SLE
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Type 4 autoimmune reaction
- delayed- type hypersensitivity by T cells
- Eg- TB, Type 1 Diabetes
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Type 5 autoimmune reaction
- mediated by organ specific Ab
- eg- myasthenia gravis, Grave’s disease
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Aschoff nodules
- Pathognomic
- Multinucleate giant cells sorrounded by T cells and macrophages
- Seen in subacute or chronic RF
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Dx criteria
Revised jones criteria
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Major criteria
- Polyarthritis
- Carditis
- Chorea
- Erythema marginatum
- subcutaneous nodules
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Minor criteria
- fever
- Arthralgia
- Previoys RF or rheumatic heart disease
- increased acute phase reactants
- Prolonged PR interval
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Polyarthritis
fleeting polyarthritis (migratory) affecting large joints
DOES NOT CAUSE PERMANENT DAMAGE
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Carditis
Pancarditis but myocarditis and pericarditis without endocarditis is rare.
MAY CAUSE PERMANENT DAMAGE
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Which side is most commonly affected in carditis
L/S> R/S
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Chorea
- emotional lability
- incoordination
- poor school performance
- uncontrolled movement
- facial grimacing
- milk maid grip
- dancing pupils
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Chorea is affecting
children more than the elderly
Females more than males
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Chorea is seen
- 1- 6 months after the infection.
- late feature
- usually no permanent damage
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Subcutaneous nodules
painless pea shaped hard nodules beneath skin, extensor surface of tendons near bony surfaces