Discussion Week #2- Patho Sample

Discussion Week #2- Patho Sample

According to the Centers for Disease Control, rheumatic fever is a systemic illness which affects   the connective tissues within arterioles which occurs after a period of an untreated strep throat infection. Generally, organisms of the Group A beta hemolytic streptococcus have notably been linked to causing this infection. These organisms induce the production of antibodies from the immune system which react with the glycogen of the heart muscles, arteries smooth muscle cells and myosin, a protein of the heart muscle cells (Carapetis et al., 2016). This induces the release of cytokines and destruction of tissues. Lesions may also develop in the heart valves and various heart layers resulting to different types of carditis. Continued inflammation causes damage to the heart valves which undergo fibrosis and scarring leading to either valve regurgitation or valve stenosis causing rheumatic heart disease in the long term (Carapetis et al., 2016). Discussion Week #2- Patho Sample

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            The typical clinical manifestations include a non-itchy rash, also known as erythema marginatum, involuntary movements of the muscles, migratory painful joints and a fever. For an accurate clinical evaluation, the recently modified Jones criterion by the American Heart Association is used. Based on this criterion, a diagnosis of rheumatic fever is made when a patient has two symptoms of the major criterion or two of the minor criterion plus one major criterion alongside evidence of high antistreptolysin O titers or a streptococcal throat infection (Carapetis et al., 2016).

According to Carapetis et al. (2016), the major criteria includes: polyarthritis, carditis, erythema marginatum, subcutaneous nodules and Sydenham chorea.  The minor criteria includes: a fever of 38.2-38.9⁰c, arthralgia, leukocytosis, positive heart block on ECG, a high ESR (Erythrocyte Sedimentation Rate) and a past episode of either an inactive heart disease or rheumatic fever. Treatment usually aims at reducing inflammation and to improve a patient’s quality of life. Therefore, anti-inflammatory medications such as corticosteroids or aspirin are often used (Carapetis et al., 2016). However, high doses of aspirin are the most preferred. In the presence of positive infection as evidenced by positive cultures for rheumatic fever, monthly Benzyl penicillin injections should be prescribed. This may be altered with low-dose antibiotics to prevent relapse. For patients who develop significant carditis in the form of heart failure, digoxin, diuretics, ACE inhibitors and beta blockers are administered.

References

Carapetis, J. R., Beaton, A., Cunningham, M. W., Guilherme, L., Karthikeyan, G., Mayosi, B. M., & Zühlke, L. (2016). Acute rheumatic fever and rheumatic heart disease. Nature reviews Disease primers, 2, 15084. Discussion Week #2- Patho Sample