Question

1-Discuss rheumatic fever and how it can lead to rheumatic heart disease.  

2-Discuss the idea that it is not the initial beta hemolytic streptococcus infection that causes the condition but an altered immune response.

3-List the signs and symptoms (and relate it to the location of the immune complexes, i.e. myocardium, endocardium, pericardium) and the treatment.  

3-Discuss the use of prophylactic antibiotics in patients who are prone to strep throat or who have experienced rheumatic fever.

Answer 1

ANSWER 1) Rheumatic fever develops as one of the complication of strep throat infection. It mainly effects the children of age group between 5- 15 years. The rheumatic fever is thought to be caused by Streptococcus group A. The rheumatic fever tends to make body attackmits own cells. This results in widespread inflammation throughtout the body. In some cases rheumatic fever causes long-term damage to heart and its valves called as rheumatic heart disease. The rheumatic fever is an inflammatory disease which causes the inflammation of the connective tissues of the body including heart muscles and valves.This inflammation is basically because of the antibodies that are present in blood and attack streptococcus as foreign bodies.

ANSWER 2) The rheumatic fever is caused initially by the beta hemolytic streptoccocus infection that later triggers the body immune response. The rheumatic fever is classified as an autoimmune disorder beacuse of the inflammation cause probably by the immune system's reaction to bacterial invasion.

ANSWER 3) The signs and symptoms of rheumatic fever are :

• Carditis: inflammation of heart is a life threathening condition. Rheumatic fever causes permanent damage to heart especially heart valves.
• Polyarthritis manifested by inflammation of joints and knee pain.
• Aschoff bodies: They are firm, painless lumps frequently found in wrist elbows, and knees.
• Erythema marginatum: They are the typical rashes with wavy and snake like appearance that has red borders and margins.
• Syndeham's chorea: its is the purposeless volatile movements of face and arms.
• Fever is present in the initial phase.
• Chest pain, heart mumur
• Fatigue

Treatment includes use of antibiotics for treating underlying strep infection , anti inflammatory medicaticans to reduce inflammation of heart and joints and anticonvulsants for syndeham's chorea. Surgical management may be needed if the endocardium is involved and inflammed as the heart valves are formed of inner lining of heart. If the pericardium and myocardium is involved then heavy steroids are used to reduce inflammation.

ANSWER 4) The patients who had rheumatic fever are at risk of having reoccurence of streptoccus infection. These people remain asymptomatic which is another factor that may be a risk for people with rheumatic heart disease. Therefore prophylactic antibiotics is used in all patients who have suffered from rheumatic heart disease with or without valvular disease. Penicillin is one of the most effective antiboitic that is used for prophylaxis treatment. Oral Sulphadiazine has also been found effective.The antibiotic therapy needs to be continued even after the surgery. The secondary prevention of RHD has proved to be effective in reducing the morbidity and mortality resulting from rheumatic fever and rheumatic heart disease.