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15.8C: Rheumatic Fever - Biology

15.8C: Rheumatic Fever - Biology


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Rheumatic fever is an inflammatory disease that can develop as a complication of inadequately treated strep throat.

Learning Objectives

  • Outline the effect of infection by Steptococcus pyogenes on the immune system

Key Points

  • Rheumatic fever is a condition that is a complication of untreated strep throat. Strep throat is caused by a group A streptococcal infection found in the throat.
  • When the body senses the strep infection, it sends antibodies to fight it and sometimes these antibodies attack the tissues of your joints or heart instead. This is known as anitbody cross-reactivity which leads to rheumatic fever.
  • Symptoms of rheumatic fever occur several weeks after initial throat problems have disappeared; and include chest pain, fever, heart problems, joint pain, nosebleeds, and skin rash.
  • Rheumatic fever is treated using a combination of antibiotics and anti-inflammatory medications.

Key Terms

  • rheumatism: Any disorder of the muscles, tendons, joints, bones, nerves, characterized by pain, discomfort and disability.
  • Streptococcus: A spherical, gram-positive bacterium of the genus Streptococcus. Although commonly found benignly in the human mouth and gut, and though many species are non-pathogenic, other species can cause diseases including strep throat and more serious conditions.

Rheumatic fever is an inflammatory disease that occurs following a Streptococcus pyogenes infection, such as streptococcal pharyngitis (strep throat) or scarlet fever, that affects the peri-arteriolar connective tissue. Believed to be caused by antibody cross-reactivity that can involve the heart, joints, skin, and brain; the illness typically develops two to three weeks after a streptococcal infection.

Acute rheumatic fever commonly appears in children between the ages of six and 15, with only 20% of first-time attacks occurring in adults. The illness is so named because of its similarity in presentation to rheumatism.

This cross-reactivity is a Type II hypersensitivity reaction and is termed molecular mimicry. During a Streptococcus infection, mature antigen -presenting cells, such as B cells, present the bacterial antigen to CD4-T cells which differentiate into helper T2cells. In turn, Helper T2 cells activate the B cells to become plasma cells and induce the production of antibodies against the cell wall of Streptococcus. However the antibodies may also react against the myocardium and joints, producing the symptoms of rheumatic fever.

Diagnosis of rheumatic fever can be made when two of the major criteria, or one major plus two minor criteria, are present along with evidence of streptococcal infection.

The major criteria for diagnosis include:

  • Arthritis in several large joints (polyarthritis)
  • Heart inflammation (carditis)
  • Nodules under the skin (subcutaneous skin nodules)
  • Rapid, jerky movements (chorea, Sydenham chorea)
  • Skin rash (erythema marginatum)

Minor Criteria:

  • Fever of 38.2–38.9 °C (101–102 F)
  • Arthralgia: Joint pain without swelling (Cannot be included if polyarthritis is present as a major symptom)
  • Raised erythrocyte sedimentation rate or C reactive protein
  • Leukocytosis
  • ECG showing features of heart block, such as a prolonged PR interval (Cannot be included if carditis is present as a major symptom)
  • Previous episode of rheumatic fever or inactive heart disease.

Acute rheumatic fever is treated with antibiotics and anti-inflammatory medications such as aspirin and corticosteroids.


15.8C: Rheumatic Fever - Biology

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Published Date: 23 Mar 2015

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Published Date: 23 Mar 2015

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Published Date: 23 Mar 2015

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Published Date: 23 Mar 2015

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Published Date: 23 Mar 2015

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Published Date: 23 Mar 2015

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Published Date: 23 Mar 2015

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Published Date: 23 Mar 2015

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Published Date: 23 Mar 2015

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Introduction

The global prevalence of rheumatic heart disease (RHD) is 1%, and is twice as common in women than men, particularly in women of childbearing age [1, 2]. This figure is likely underestimated in developing countries [2]. RHD accounts for approximately 30% of cardiac disease in pregnancy in developed countries, and 90% of cardiac disease in non-industrialized regions [3, 4].

Normal hemodynamic changes of pregnancy impose an additional 30–50% cardiac load. This is well tolerated by a normal heart but can result in morbidity and mortality in women with pre-existing RHD [5–7]. Mitral stenosis (MS) is especially sensitive to cardiac insufficiency in pregnancy [8, 9]. The placental-fetal heart circulation is likely affected [10], and hemodynamic insufficiency poses a risk to the developing fetus. Complications such as intra-uterine growth restriction (IUGR) and prematurity may have lasting developmental effects into childhood and beyond [11].

The New York Heart Association (NYHA) functional classification of heart failure is used worldwide, with four categories (I-IV) based on limitations during physical activity Class I–no limit, to Class IV- symptoms at rest [12]. In addition, MS severity can be graded using echocardiography based on mitral-valve area (MVA) into mild (>1.5cm 2 ), moderate (1.0–1.5cm 2 ) and severe (<1.0cm 2 ) [13]. Increasing severity of these indicators (NYHA, MVA) is associated with increased frequency of maternal cardiac complications [9]. In contrast, the association with adverse fetal and neonatal outcomes is often unreported.

The purpose of this study was to review rates of adverse fetal and neonatal outcomes for women with RHD in pregnancy and investigate the association between increasing severity of RHD using the NYHA and MVA scales with fetal outcomes. Additionally, the effects of percutaneous balloon mitral valvuloplasty (PBMV) on fetal events is reported.


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15.8C: Rheumatic Fever - Biology

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NR 602 Midterm Exam &ndash Question and Answers&NewLine&NewLineRole-play with equipment during the course of a physical examination would be most beneficial with which of the following groups&quest&NewLineWhat is the Ortolani Sign&quest&NewLineWhen performing a physical examination of a toddler&comma which of the following body parts would examine last&quest&NewLineWhat are three findings using Jones criteria for Rheumatic Fever&quest&NewLineWhile examining a 4-month-old boy&comma you are unable to palpate one of his testes&period The next most appropriate step is&colon&NewLineConcurren&period&period&period

NR 602 Midterm Exam &ndash Question and Answers&NewLine&NewLineRole-play with equipment during the course of a physical examination would be most beneficial with which of the following groups&quest&NewLineWhat is the Ortolani Sign&quest&NewLineWhen performing a physical examination of a toddler&comma which of the following body parts would examine last&quest&NewLineWhat are three findings using Jones criteria for Rheumatic Fever&quest&NewLineWhile examining a 4-month-old boy&comma you are unable to palpate one of his testes&period The next most appropriate step is&colon&NewLineConcurren&period&period&period

NR 602 MIDTERM EXAM &ndash QUESTION AND ANSWERS

NR 602 MIDTERM EXAM &ndash QUESTION AND ANSWERS

NR 602 MIDTERM EXAM &ndash QUESTION AND ANSWERS

NR 602 MIDTERM EXAM &ndash QUESTION AND ANSWERS

NR 602 Midterm Exam &ndash Question and Answers&NewLine&NewLineRole-play with equipment during the course of a physical examination would be most beneficial with which of the following groups&quest&NewLineWhat is the Ortolani Sign&quest&NewLineWhen performing a physical examination of a toddler&comma which of the following body parts would examine last&quest&NewLineWhat are three findings using Jones criteria for Rheumatic Fever&quest&NewLineWhile examining a 4-month-old boy&comma you are unable to palpate one of his testes&period The next most appropriate step is&colon&NewLineConcurren&period&period&period

NR 602 Midterm Exam &ndash Question and Answers&NewLine&NewLineRole-play with equipment during the course of a physical examination would be most beneficial with which of the following groups&quest&NewLineWhat is the Ortolani Sign&quest&NewLineWhen performing a physical examination of a toddler&comma which of the following body parts would examine last&quest&NewLineWhat are three findings using Jones criteria for Rheumatic Fever&quest&NewLineWhile examining a 4-month-old boy&comma you are unable to palpate one of his testes&period The next most appropriate step is&colon&NewLineConcurren&period&period&period

NR 602 Midterm Exam &ndash Question and Answers &NewLine &NewLineRole-play with equipment during the course of a physical examination would be most beneficial with which of the following groups&quest &NewLineWhat is the Ortolani Sign&quest &NewLineWhen performing a physical examination of a toddler&comma which of the following body parts would examine last&quest &NewLineWhat are three findings using Jones criteria for Rheumatic Fever&quest &NewLineWhile examining a 4-month-old boy&comma you are unable to palpate one of his testes&period The next most appropriate step is&colon &NewLineCo&period&period&period

NR 602 Midterm Exam &ndash Question and Answers &NewLine &NewLineRole-play with equipment during the course of a physical examination would be most beneficial with which of the following groups&quest &NewLineWhat is the Ortolani Sign&quest &NewLineWhen performing a physical examination of a toddler&comma which of the following body parts would examine last&quest &NewLineWhat are three findings using Jones criteria for Rheumatic Fever&quest &NewLineWhile examining a 4-month-old boy&comma you are unable to palpate one of his testes&period The next most appropriate step is&colon &NewLineCo&period&period&period

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NR 602 Midterm Exam &ndash Question and Answers&NewLine&NewLineRole-play with equipment during the course of a physical examination would be most beneficial with which of the following groups&quest&NewLineWhat is the Ortolani Sign&quest&NewLineWhen performing a physical examination of a toddler&comma which of the following body parts would examine last&quest&NewLineWhat are three findings using Jones criteria for Rheumatic Fever&quest&NewLineWhile examining a 4-month-old boy&comma you are unable to palpate one of his testes&period The next most appropriate step is&colon&NewLineConcurren&period&period&period

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NR 602 Midterm Exam &ndash Question and Answers&NewLine&NewLineRole-play with equipment during the course of a physical examination would be most beneficial with which of the following groups&quest&NewLineWhat is the Ortolani Sign&quest&NewLineWhen performing a physical examination of a toddler&comma which of the following body parts would examine last&quest&NewLineWhat are three findings using Jones criteria for Rheumatic Fever&quest&NewLineWhile examining a 4-month-old boy&comma you are unable to palpate one of his testes&period The next most appropriate step is&colon&NewLineConcurren&period&period&period

-NR 602 Midterm Exam &ndash Question and Answers &NewLine-NR 602 Midterm Exam &ndash Question and Answers

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NR 602 Midterm Exam &ndash Question and Answers&NewLine&NewLineRole-play with equipment during the course of a physical examination would be most beneficial with which of the following groups&quest&NewLineWhat is the Ortolani Sign&quest&NewLineWhen performing a physical examination of a toddler&comma which of the following body parts would examine last&quest&NewLineWhat are three findings using Jones criteria for Rheumatic Fever&quest&NewLineWhile examining a 4-month-old boy&comma you are unable to palpate one of his testes&period The next most appropriate step is&colon&NewLineConcurren&period&period&period

NR 602 Midterm Exam &ndash Question and Answers&NewLine&NewLineRole-play with equipment during the course of a physical examination would be most beneficial with which of the following groups&quest&NewLineWhat is the Ortolani Sign&quest&NewLineWhen performing a physical examination of a toddler&comma which of the following body parts would examine last&quest&NewLineWhat are three findings using Jones criteria for Rheumatic Fever&quest&NewLineWhile examining a 4-month-old boy&comma you are unable to palpate one of his testes&period The next most appropriate step is&colon&NewLineConcurren&period&period&period

NR 602 Midterm Exam &ndash Question and Answers Role-play with equipment during the course of a physical examination would be most beneficial with which of the following groups&quest What is the Ortolani Sign&quest When performing a physical examination of a toddler&comma which of the following body parts would examine last&quest What are three findings using Jones criteria for Rheumatic Fever&quest While examining a 4-month-old boy&comma you are unable to palpate one of his testes&period The next most appropriate step is&colon Concurrent&period&period&period

NR 602 Midterm Exam &ndash Question and Answers Role-play with equipment during the course of a physical examination would be most beneficial with which of the following groups&quest What is the Ortolani Sign&quest When performing a physical examination of a toddler&comma which of the following body parts would examine last&quest What are three findings using Jones criteria for Rheumatic Fever&quest While examining a 4-month-old boy&comma you are unable to palpate one of his testes&period The next most appropriate step is&colon Concurrent&period&period&period



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