Documente Academic
Documente Profesional
Documente Cultură
By
Dr Bashir Ahmed Dar
Chinkipora Sopore
Kashmir
Associate Professor
Medicine
Email
drbashir123@gmail.com
RHEUMATIC FEVER
Is a post streptococcal infection caused by group A
beta hemolytic streptococci.Occurs usually after an
attack of phyrangitis
Between age group of 5-15years.
Male and female equally affected
Can also occur at any age
What are these Streptococci
A ‘coccus’ is a spherical
bacteria
Staphylococcus tend to
cluster in groups
While Streptococcus
tend to line up in strings
Some are pyogenic while
others are non pyogenic.
Classification of Streptococci
Streptococciare classified according to their
hemolytic ability after incubation overnight on
blood agar medium.
.
Crowding increases the opportunity for the pathogen to
spread, particularly during the winter months.
the organisms are introduced into the superficial or deep
tissue through a break in the skin.
Low social economic conditions are at risk.
Portal of entry through droplets,contact,food,fomites.
How does streptococci cause
Rheumatic fever
The streptococci contain antigens as already
said , to these antigens antibodies are
formed in the body.
But before these antibodies are formed the
streptococcal infection is over
How does streptococci cause
Rheumatic fever
So these antibodies are searching streptococci but
find none there
Instead these antibodies now react to various
tissues in the body.
Since most cells of body have same constituents as
that of streptococcal cells therefore react with cells
of body causing antigen antibody reaction.thus
rheumatic fever is immune mediated.
How does streptococci cause
Rheumatic fever
Stick in Perforation
Mitral Valve
Acute Rheumatic vegetations:
Mitral v.
Va
lve
Vegetations
Papillary muscle
How are Aschoff bodies
formed
Formed in 3 stages.
1. Early (Exudative or degenerative) stage.
Initially, there is oedema of the connective tissue
and increase in acid mucopolysaccharide in the
ground substance.This results in separation of the
collagen fibres by accumulating ground
substance.Eventually, the collagen fibres are
fragmented and disintegrated,that takes the stain
of a fibrin.hence called fibrinoid degeneration.
How are Aschoff bodies
formed
2. 2nd stage (Proliferative or granulomatous)
This includes infiltration by lymphocytes
(mostly T cells),plasma cells, a few
neutrophils and the characteristic cardiac
histiocytes (Anitschkow cells) at the margin
of the lesion.
Acute RF: Aschoff body
Aschoff body:
– Fibrinoid degeneration
– T lymphocytes
– Plasma cells
– Macrophages
Anitschkow cells
Aschoff giant cells
– Around blood vessel.
Aschoff body in Acute RF
Anitschkow cells
Capillary
T lymphocyte
Myocyte
Aschoff body in Acute RF
Fibrinoid necrosis
Aschoff giant cells.
Cardiac Muscle
fibres.
Cardiac histiocytes or
Anitschkow cells
o d y
o f f B
As c h
Aschoff Giant Cells:
Acute Rheumatic Fever-Rh
nodule
How are Aschoff bodies
formed
Va
lve
Vegetations
Papillary muscle
Fish mouth stenosis:
Rheumatic Valvulitis
The vegetations in RF appear grey-brown,
transuuent and are firmly attached so that
they are not likely to get detached to form
emboli, unlike the friable vegetations of
infective endocarditis.
Chronic RHD:
Valve leaflet
thickening.
Shortening, thickening
and fusion of chordae
tendineae.
Acute on Chronic RHD
Scar nodule
Mitral Valve
Left Atrium
Chronic RHD - Aortic Valve
Sten
otic
, Fu
sed
valv
e
Cor
ona
ry A
rter
y (n
orm
al)
Fish mouth Mitral stenosis:
Rheumatic Valvulitis
Stick in Perforation
Mitral Valve