Cardiovascular System >
Rheumatic Fever

“An autoimmune condition triggered by streptococcal bacteria causing a multi-system disorder that affects the joints, heart, skin and nervous system”

Risk Factors
  • Family history
  • Environmental factors (poor sanitation, overcrowding, poverty)
Aetiology
  • Group A streptococcal infection triggering an autoimmune response
Pathophysiology
  1. Streptococcal infection (tonsillitis)
  2. The immune system creates antibodies
  3. Antibodies target bacteria but also antigens on the cells of the patient
  4. Type 2 hypersensitivity reaction
Clinical Presentation
  • Typical presentation – Occurs 2-4 weeks following a streptococcal infection
  • Joint symptoms:
    • Migratory arthritis of large joints (hot, swollen, painful joints)
  • Cardiac symptoms:
    • Carditis with pericarditis, myocarditis, and endocarditis leading to tachycardia or bradycardia
    • Murmurs
    • Pericardial rub
    • Heart failure
  • Skin symptoms:
    • Subcutaneous nodules
    • Erythema marginatum rash (pink rings of various size on the torso and proximal limbs)
  • Nervous system symptoms:
    • Chorea (irregular, uncontrolled and rapid limb movements)
Investigations
  • Bloods:
    • Anti-streptococcal antibody titre – indicate recent streptococcal infection
  • Imaging:
    • Echocardiogram
    • Chest X-Ray
  • Special:
    • ECG
    • Throat swab – for bacterial culture
  • Jones criteria:
    • Streptococcal infection alongside >2 major criteria or 1 major, >2 minor criteria confirms rheumatic fevers
    • Major criteria – joint arthritis, organ inflammation, nodules, erythema marginatum rash, sydenham chorea
    • Minor criteria – fever, ECG changes without carditis, arthralgia without arthritis, raised inflammatory markers)
Management
  • Conservative: n/a
  • Medical:
    • Antibiotics for streptococcal infection (penicillin)
    • NSAIDs (joint pain)
    • Aspirin and steroids (treat carditis)
    • Prophylactic antibiotics are used to prevent further streptococcal infections and recurrence of rheumatic fever
  • Surgical: n/a
Complications
  • Recurrence of rheumatic fever
  • Valvular heart disease (most notably mitral stenosis)
  • Chronic heart failure

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