Rheumatic Fever: Etiology, Pathophysiology, Pathology, Clinical Features, Diagnostic Criteria, and Complications

Introduction

Rheumatic fever is a systemic inflammatory disease that occurs as a result of an autoimmune response to an untreated or inadequately treated Group A Streptococcal infection. It primarily affects the heart, joints, skin, and nervous system.

Etiology

The disease is caused by an exaggerated immune response to Streptococcus pyogenes, leading to molecular mimicry and cross-reactivity between bacterial antigens and host tissues.

Pathophysiology

Rheumatic fever results from an abnormal immune response triggered by streptococcal infections, leading to inflammation and tissue damage across multiple organs.

Pathology

The disease may involve Aschoff bodies in the heart, fibrinoid necrosis, and chronic inflammation, ultimately leading to rheumatic heart disease.

Clinical Features

• Carditis – valvular inflammation causing murmurs
• Polyarthritis – migratory inflammation of large joints
• Erythema marginatum – characteristic rash
• Subcutaneous nodules – firm painless nodules
• Chorea – involuntary movements due to neurological involvement

Diagnostic Criteria

The diagnosis follows the modified Jones criteria, requiring evidence of prior streptococcal infection along with major and minor clinical manifestations.

Complications

Long-term effects include chronic valvular heart disease, heart failure, and repeated episodes of acute rheumatic fever.

Conclusion

Early identification and treatment of streptococcal infections are crucial in preventing rheumatic fever and its complications.