Define rheumatic fever. what are the main causes of rheumatic fever. List the clinical finding of rheumatic fever. To list and identify the most commonly used laboratory tests to detect the rheumatic fever. How to treat rheumatic fever . To list some of the procedures that are used for the prevention of the rheumatic fever .

1. SSC MODULE
Clinical Lab Science ( CLS Micro. )
Done by:
Republic of Iraq
Ministry of Higher Education
and Scientific Research
University of Baghdad
College of Medicine
6/27/2018 1
Rheumatic fever
Amna Easa Mohammed Jafer

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Objective :
1) Define rheumatic fever.
2) what are the main causes of rheumatic fever.
3) List the clinical finding of rheumatic fever.
4) To list and identify the most commonly used laboratory
tests to detect the rheumatic fever.
5) How to treat rheumatic fever .
6) To list some of the procedures that are used for the
prevention of the rheumatic fever .

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Introduction:
- an auto-immune response to group A streptococcus (GAS) infection of the
upper respiratory tract.
- Recurrences of rheumatic fever are likely in the absence of preventative measures and
may cause further cardiac valve and muscle damage, leading to heart failure, strokes
and premature death .

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-When the inflammation leads
to permanent damage of the
valves the individual has
rheumatic heart disease
(RHD).
Etiopathogenesis:
 - (ARF) is a delayed non suppurative
sequel of pharyngeal infection with
group A beta hemolytic Streptococcus
(GABHS).
 The bacteria is very rich in M-protein.
 This type of protein is highly antigenic

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Pathogenesis :
 Antibodies produced against the streptococcal antigens cause inflammation in the
endocardium, myocardium and pericardium, as well as the joints and skin.
 Acute rheumatic fever usually affects children (most commonly between 5 and
15 years) or people in area of poverty and crowdin .

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Clinical finding :
Migratory polyarthritis.
Pancarditis :
inflammation of all three layers of the heart tissue:
Major Manifestations :

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• Endocarditis :
• Myocarditis :
- Inflamed area in the myocardial tissue called Aschoff bodies
- It is the most common cause of death.
• Pericarditis :
Cause pain and
friction rub .
In the acute stage of inflammation there
is roughening and in chronic stage there
is thickening of the surface linings

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 Subcutaneous nodules:
They are 0.5–2 cm in diameter, round,
firm, freely mobile and painless
nodules.
 Erythema marginatum :
 occur mainly on the trunk and
proximal extremities
 They are small , firm and
painless
 Sydenham’s chorea :
A rapid movement in the face
and the arm.

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Minor manifestations :
Fever :Usually it is of high grade (more than 39° C)
and persists for 7 to 10 days
Arthralgia :there is pain on joint movement without
evidence of swelling or heat.
(A confident diagnosis of rheumatic fever can usually be made if at least two
'major' symptoms are present, or there is one major symptom and two
'minor' symptoms.)

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Other diagnostic method:
 Blood test :
1. C reactive protein (CRP)
2. Antistreptolysin O titre (ASOT)
3. Erythrocyte sedimentation rate (ESR)
 Electrocardiograph (ECG) :
PR prolongation is seen in 25 percent of
cases of ARF.
 Echocardiograph :

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Treatment plan :
 use anti-inflammatory medications .
 use antibiotics
 ensure to have plenty of bed rest.
- anti-inflammatory :
• (aspirin) are recommended as first-line treatment
• The duration of treatment is dictated by the clinical
response and improvement in inflammatory
markers (ESR, CRP)
- CHOREA :
• by providing a calm environment.
• carbamazepine or sodium valproate

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By adequate antibiotic therapy of group A streptococcal upper
respiratory tract (URT) infections to prevent an initial attack of
acute RF
Prevention :
Primary prevention:
Secondary prevention :
Penicillin is again the agent of choice for secondary
prophylaxis, but sulfadiazine or a macrolide or azalide are
acceptable alternatives in penicillin-allergic individuals.

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Summary :
Acute rheumatic fever is an auto-immune response to group A
streptococcus (GAS) infection of the upper respiratory tract.
Antibodies produced against the streptococcal antigens cause
inflammation in the endocardium, myocardium and
pericardium, as well as the joints and skin. Diagnosis is
clinical and relies on the Jones criteria. anti-inflammatory
medications to relieve symptoms.use antibiotics to get rid of
any remaining streptococcus bacteria in your child's body

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Thank you