Rheumatic fever is an acute inflammatory disease that occurs weeks after a streptococcal throat infection. It affects the heart, joints, skin, and brain. It is caused by an autoimmune response triggered by the throat infection. Symptoms include migratory arthritis, heart inflammation, skin nodules, rashes, and neurological symptoms like Sydenham's chorea. Diagnosis is based on symptoms and evidence of prior streptococcal infection. It can lead to long term rheumatic heart disease with valve damage and heart failure if not properly treated.

1. Rheumatic feverRheumatic fever
&&
Rheumatic heart diseaseRheumatic heart disease
Dr.SundaresanDr.Sundaresan
PathologyPathology
Loyola collegeLoyola college

2. Rheumatic feverRheumatic fever
&&
Rheumatic heartRheumatic heart
diseasedisease

3. Rheumatic fever is an acuteRheumatic fever is an acute
immunologically mediated ,immunologically mediated ,
multisystem inflammatorymultisystem inflammatory
disease that occurs a fewdisease that occurs a few
weeks following an episode ofweeks following an episode of
group A streptococcalgroup A streptococcal
pharyngitis .pharyngitis .

4. Poverty, poor hygiene ,Poverty, poor hygiene ,
overcrowdedovercrowded
Age – 5 – 15 yrs.Age – 5 – 15 yrs.
10 days – 6 weeks after GAS10 days – 6 weeks after GAS
infection.infection.
Affects 3 % of patients.Affects 3 % of patients.
20 % in adults.20 % in adults.
Recurrent attacks causeRecurrent attacks cause
cumulative damage .cumulative damage .

5. AffectsAffects
TendonsTendons
JointsJoints
FasciaeFasciae
MusclesMuscles
ArteriesArteries
SubcutisSubcutis
Connective tissueConnective tissue
Lungs , brain , heartLungs , brain , heart

6. PathogenesisPathogenesis
HypersensitivityHypersensitivity
Autoimmune responseAutoimmune response
Genetic susceptibilityGenetic susceptibility

10. Clinical featuresClinical features

11. Migratory polyarthritisMigratory polyarthritis
CarditisCarditis
Subcutaneous noduleSubcutaneous nodule
Erythema marginatumErythema marginatum
Sydenham choreaSydenham chorea
FeverFever

14. MigratoryMigratory
polyarthritispolyarthritis

16. Subcutaneous nodulesSubcutaneous nodules

17. Erythema marginatumErythema marginatum

18. Erythema marginatumErythema marginatum

19. Sydenham choreaSydenham chorea

20. InvestigationsInvestigations

21. ↑↑ acute phase proteinsacute phase proteins
↑↑ ESRESR
↑↑ ASO titer , ↑ antiDNAse B.ASO titer , ↑ antiDNAse B.
Throat cultureThroat culture
ImagingImaging
ECG – prolonged PR interval.ECG – prolonged PR interval.
EchoEcho

26. (30 %)
(75 – 80 %)
(5 %)

27. Jones criteriaJones criteria
2 major or 1 major & 2 minor2 major or 1 major & 2 minor

29. MorphologyMorphology

30. Enlarged heartEnlarged heart
Valve vegetations – verrucaeValve vegetations – verrucae
Maccallum plaques in left atriumMaccallum plaques in left atrium
Pericardial effusionPericardial effusion
Aschoff bodies in myocardiumAschoff bodies in myocardium
PancarditisPancarditis
Valve deformity in chronic RHD.Valve deformity in chronic RHD.

44. Aschoff bodyAschoff body

45. Aschoff giant cell
Anitschkow cells or caterpillar cells

48. ComplicationsComplications
Embolic episodesEmbolic episodes
Infective endocarditisInfective endocarditis
Pericardial effusionPericardial effusion
Valvular defect with cardiacValvular defect with cardiac
hypertrophyhypertrophy
Cardiac failureCardiac failure
Atrial fibrillationAtrial fibrillation
Rheumatic pneumonitisRheumatic pneumonitis