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Case 3: Rheumatic Fever > Rheumatic Fever > Flashcards

Rheumatic Fever Flashcards

1
Q

Definition of rheumatic fever

A

Post throat group A B haemolytic streptococcus Pyogenes infection
Acute, immunologically mediated multi system inflammatory disease
Ag-Ab cross reactivity

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2
Q

Criteria of rheumatic fever

A

Joints
Obvious pancarditis
Nodules (subcutaneous)
Erythema marginatum
Sydenham marginatum

Temperature
ESR/CRP
Raised PR interval
Inflammatory cells
Arthralgia

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3
Q

Acute rheumatic heart diseases features

A

Pancarditis:
1. Epicardium: fibrin & Ag-Ab deposits at line of closure (not friable)
2. Myocardium: pathognomonic Aschoff bodies (eosinophils, macrophages- Anitschkow cells & lymphocytes)
3. Pericardium: fibrinous bread & butter appearance

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4
Q

Chronic rheumatic heart disease features

A
  1. Valves: fibrosis (dystrophic calcification) & angiogenesis with fish mouth appearance at mitral valve (also AV & PV)
  2. Chordae tendinae shortens & thickens
    Sequels of chronic RHD
    Valvular stenosis (valve thickening & fusion) & regurgitation (chordae tendinae & cusps shortening)
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5
Q

4 complications of rheumatic fever

A
  1. Infective endocarditis
  2. Atrial fibrillation
  3. Thrombus & embolus
  4. Heart failure
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6
Q

2 risk factors of rheumatic fever

A
  1. Environment: poor SES, overcrowded, poor nutrition & health care
  2. Age: ARF 5-14 years, reoccurrence at older & RHD 25-45 years
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7
Q

2 management strategies of rheumatic heart disease

A

Valvuloplasty
Valve replacement

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8
Q

How is rheumatic fever transmitted

A

Droplet
Airborne/foodborne
Contact

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9
Q

What is the pathogenesis of rheumatic fever

A
  1. GAS adhesion & evasion of pharyngeal epithelium
  2. GAS antigen processing & presentation to T & B cells
  3. Generation of cross reactive M protein
  4. Tissue & organ manifestation
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10
Q

What is the clinical course of rheumatic fever

A

GAS exposure with 2-4 days incubation throat infection with 1-5 weeks incubation to ARF (treatment with penicillin to prevent)
10-20 years incubation to RHD (treat with benzathine penicillin to prevent)
Recurrent RF to RHD (treat with benzathine penicillin to prevent)

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11
Q

What is the cause of the tissue destruction in rheumatic fever

A

Not result of tissue destruction by microorganisms but rather cross reactive antibodies to GAS & host cardiac tissue
Molecular mimicry antibodies produced to attack M protein cross react with heart muscle tissue

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12
Q

What is valvular stenosis

A

Valve can not open
Forward flow hindered
Increase in pressure & pressure overload

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13
Q

Valvular regurgitation/incompetence

A

Valve can not close
Backflow
Increase volume & volume overload

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14
Q

4 clinical consequences for stenosis or regurgitation

A
  1. Which valve is involved
  2. How fast did it occur
  3. Degree of involvement
  4. Compensatory mechanism effectiveness
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15
Q

What type of hypersensitivity reaction is rheumatic fever

A

Type 2

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16
Q

What side is most affected by valve pathologies and why

A

Left side due to metabolic active
Right side uncommon seen in IV drug users

17
Q

What is the 2 causes of valvular stenosis

A
  1. Valvular abnormalities: rheumatic valvulitis or infective endocarditis
  2. Congenital abnormalities: congenital stenotic valve & bicuspid valve
18
Q

What is the diagnostic criteria for diagnosing rheumatic fever initially and recurrent

A

Initially: 2 major or 1 major and 2 minor
Recurrent: 2 major or 1 major and 2 minor or 3 minor

19
Q

What is 3 causes of valvular regurgitation

A
  1. Valvular abnormalities: rheumatic valvulitis & infective endocarditis
  2. Valve annulus damage: valve distension (aortic & pulmonary valve)
  3. Damage to papillary muscle & chordae tendinae (valve distension, rheumatic valvulitis, stab or MI)
20
Q

What supports the cell mediated theory of rheumatic fever & what cytokines are released

A

Presence of Aschoff bodies
IL-17 & 23

21
Q

What is the 3 part of adapted Koch’s postulates

A
  1. Evidence of disease specific adaptive immune response in affected target tissue
  2. Auto reactive T or B cells &/ autoantibodies
  3. Elimination of autoimmune response via medication dampens disease progression

Case 3: Rheumatic Fever (5 decks)

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