This article is based on the guidelines provided by the AWMF, the Association of the Scientific Medical Societies in Germany.
Table of Contents
- Definition of Rheumatic Fever
- Epidemiology of Rheumatic Fever
- Etiology of Rheumatic Fever
- Pathophysiology of Rheumatic Fever
- Clinical Presentation of Rheumatic Fever
- Diagnostics of Rheumatic Fever
- Pathology of Rheumatic Fever
- Differential Diagnosis of Rheumatic Fever
- Therapyof Rheumatic Fever
- Review Questions
Definition of Rheumatic Fever
Rheumatic Fever After an Infection
Rheumatic fever is an inflammatory reaction to bacterial toxins after an infection with group A streptococci.
Epidemiology of Rheumatic Fever
Distribution of Rheumatic Fever
Since in industrial countries streptococci infections of the oropharyngeal tract are usually treated with antibiotics (i.e., penicillin), this disease is very rare in these regions. In developing countries, rheumatic fever plays an important role, especially in the age of 5 to 15.
Etiology of Rheumatic Fever
Causes of Rheumatic Fever
For example, an angina tonsillaris or pharyngitis due to streptococci A may lead to an infection-induced autoimmune reaction, which in turn can cause the rheumatic fever.
Pathophysiology of Rheumatic Fever
Clinical Presentation of Rheumatic Fever
Occurrence of Rheumatic Fever
Typically, rheumatic fever occurs two to three weeks after a declined infection. It presents as general symptoms like fever, headaches, and sweating. Also, migrating polyarthritis with swelling and reddening occurs. The heart can also be affected by rheumatic fever. Depending on which structure is affected, the disease can expand to a pancarditis. Subcutaneous rheumatic nodes can be found on the skin.
A late sequela is Sydenham disease (chorea minor), which can occur months after the infection with the streptococci.
Diagnostics of Rheumatic Fever
Clinical Examination of Rheumatic Fever
The clinical examination shows a friction rub on auscultation and signs of pericardial effusion or heart insufficiency. Also, tachycardia and cardiac dysrhythmia can occur, just like audible cardiac murmurs if cardiac valves are affected.
Laboratory tests may reveal increased inflammatory parameters. Also, streptococci can be detected in the throat swab. Antibodies like antistreptolysin O or anti-desoxyribonuclease B can be determined. If the cardiac valves are affected, this can be detected in echocardiography. The ECG can demonstrate unspecific changes.
Pathology of Rheumatic Fever
Histology of Rheumatic Fever
Histologically, so-called Aschoff bodies (image on the right) can be found, which consist of fibrinoid necroses around which rotund and giant cells have accumulated. Also, Anitschkow’s cells, which are histiocytes with owl-like nucleoli, are typical of rheumatic fever.
Differential Diagnosis of Rheumatic Fever
The rheumatoid arthritis has to be distinguished from rheumatic fever.
Therapyof Rheumatic Fever
Treatment of Rheumatic Fever
Both penicillin V and amoxicillin are suitable for treatment. A change to macrolides is possible if an allergy against penicillin is present. For treatment of the inflammation, NSAIDs are used. For prophylaxis of relapses, penicillin or a macrolide has to be administered for at least five years.
Answers can be found below the references.
1. Which is usually the cause of rheumatic fever?
- A cold.
- A previous streptococci infection.
- An endocarditis.
- A myocarditis.
- It develops idiophatically.
2. Which is most likely part of the pathological picture of rheumatic fever?
- Osler’s nodes
- Microabscesses with bacteria
- Aschoff bodies
- Serous exudate
3. Which is the first-choice treatment for rheumatic fever?