Pathology - Acute Rheumatic Fever and Rheumatic Heart Disease
Acute rheumatic fever (ARF): Antibodies produced in response to group A Beta-hemolytic streptococci exhibit cross-reactivity with the patient's tissues, typically manifesting in youngsters aged 3-15 years. Rheumatic heart disease is a condition that occurs as a result of acute rheumatic fever and often manifests 20 or more years after the initial episode. ARF is characterized by the presence of Aschoff bodies, which are inflammatory foci surrounded by lymphocytes, and Anitschkow cells, which are macrophages that may become multinucleated. These cells cause pancarditis, an inflammation of the heart tissue. Additionally, there is a serofibrinous pericardial effusion. RHD: Mitral stenosis characterized by fish-mouth deformity, which may also impact the aortic valve. Acute rheumatic fever (ARF) is characterized by the appearance of symptoms 2-3 weeks after streptococcal pharyngitis. The major Jones criteria for diagnosing ARF include carditis (inflammation of the heart), migratory polyarthritis (inflammation of multiple joints that moves from one joint to another), chorea (involuntary movements), erythema marginatum (a rash that is pale in the center and has a ring-shaped appearance), and subcutaneous nodules (lumps under the skin). The minor Jones criteria include fever, arthralgia (joint pain), or evidence of a previous streptococcal infection (positive ASO titer). Laboratory results: Increased erythrocyte sedimentation rate (ESR). RHD: Manifests with valvular heart disease, typically mitral stenosis, but may also involve aortic stenosis. Valvular disease can result in cardiac hypertrophy, arrhythmias, and heart failure. Penicillin is used to treat streptococcal infections, while salicylates are used to alleviate fever and arthritis. RHD: Administer endocarditis prophylaxis if necessary; consider valve replacement for severe, symptomatic valvular disease.
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