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1. Acute rheumatic fever and
Infective endocarditis
By: Ramanova Barno
Group: 301C
Faculty: 1st medicine faculty

2. Rheumatic fever
Immunological disorder initiated
by group A beta hemolytic
Streptococcus

3. Rheumatic fever
It’s characterized by an exudative and proliferative
inflammatory lesion of the connective tissue, especially
that of the
Heart
Joints
Blood vessels
And subcutaneous tissue.

4. “Licks the joint, bites the heart”
Acute ARF is an immuno-inflammatory condition
that presents as a connective tissue disease,
clinically manifesting as
Carditis
Arthritis
Sometimes with chorea
Subcutaneus nodules
And erythema marginatum

5. Etiology
An untreated Group – A beta hemolytic
streptococcal infection is the commonest
antecedent event that precipitates an attack
of Acute Rheumatic Fever.
It is delayed non-suppurative sequelae to
URTI with GABH streptococci

6. Rheumatic fever
Predisposing factors –
Low socioeconomic status
Overcrowding
Poor nutrition
Poor hygiene
- Genetic predisposition.

7. Rheumatic fever
A triad of syndroms may result
The joints – Rheumatic fever
(Rheumatic polyarthritis)
Heart – Rheumatic pancarditis
Brain - Chorea

8. Clinics
There are major and minor Kisel-Jones criteria for ARF:
Large criteria:
 Rheumatic carditis (usually endomyocarditis)
 Polyarthritis (large joints, migratory inflammation, without
deformities)
 Minor chorea (convulsions due to damage to subcortical structures)
 Rheumatic nodules (subcutaneous lumps)
 Anular erythema (redness on the skin of the trunk and limbs)
Minor criteria:
 Fever
 Joint pain

9. Prevention
There are primary, secondary and ongoing prevention of ARF.
Primary. Timely treatment of sore throats, caries, sinusitis, child
hardening.
Secondary. Bicillin prophylaxis
(extencillin 2,4 mln units every 3 weeks):
At least 5 years.
When the disease manifests itself in adolescence without the formation
of heart disease up to 18 years
Manifestation with heart disease up to 25 years
Current. Mandatory prescription of penicillins and NSAIDs for
inflammatory diseases.
ARF is dangerous due to the formation of heart defects if treatment is
started late.

10. Infective endocarditis
• infective endocarditis - is a microbial infection
of the endocardial (endothelial) surface of the
heart.
• The vegetation is a variable sized amorphous
mass of platelates and fibrin in which abundant
micro-organisms and scant inflammatory cells
are enmeshed.

11. Classification
• Acute
- Affects normal heart valves
- Rapidly destructive
- Metastatic foci
- Commonly Staph.
- If not treated, usually fatal within 6 weeks
• Subacute
- Often affects damaged heart valves
- Indolent nature
- If not treated, usually fatal by one year

12. Clinical Manifestations
Fever, most common symptom, sign
• Anorexia, weight-loss, malaise, night sweats
• Heart murmur
• Petechiae on the skin, conjunctivae, oral mucosa
• Splenomegaly
• Right-sided endocarditis is not associated with peripheral emboli/phenomena
but pulmonary findings predominate