Acute rheumatic fever (ARF) is defined by Mosby (2010) as a systemic inflammatory disease which is enabled development with inadequate treatment of upper respiratory tract infections of group A beta-hemolytic streptococci. Repeated episodes of ARF can cause autoimmune reactions within the heart which in turn inflicts damage upon the heart muscle and heart valves, a condition termed as rheumatic heart disease (RHD) (Mosby, 2010). Predominately ARF and RDH cases are found to effect people living in developing countries. Steer and Carapetis (2009), have linked this issue with the lowered socioeconomic conditions, household crowding, inadequate health care and poor hygiene. In comparison both ARF and RHD have virtually been eliminated in …show more content…
Although the pathogenic mechanism of ARF and RHD is not yet fully understood, a correlation between rheumatogenic GAS strains and inheritably liable hosts, results in abnormal immune responses and the development of autoimmunity (Steer & Carapetis, 2009). This is caused by antibody cross-reactivity and more specifically a result of molecular mimicry (Porth & Matfin, 2009). In the usual situation of a streptococcus infection, an immune response will be instigated involving B cell presentation of the antigen, CD4- T cell differentiation, helper T cell formation and plasma B cell antibody production. Through this process the antibodies are enabled to destruct the precise protein structure of the GAS cell wall. However in this case, the targeted protein of the bacterium has considerable similarity to antigens presented on the heart and kidney tissues which causes autoimmune activity. Once the micro organisms have been eradicated, the remaining antibodies mistake the identity of certain somatic cell resulting in inflammation and the onset of ARF symptoms two to three weeks after the absence of the infection (Porth & Matfin, 2009).
Typical presentations of rheumatic fever (RF) include a history of sore throats, head aches, fever, abdominal pain, nausea and vomiting, swollen glands and other common signs and symptoms of streptococcal infection (Porth & Matfin, 2009). The presentation of RF can be acute, recurrent or chronic. The acute stage
Cardiovascular diseases (CVD) extended to involve the developing countries this is probably due to change in life style and dietary habits, one of the examples in developing countries is India were the mortality from CVD increased to 103% in men and by 90% in women from 1985 to 2015 (WHO 2003), (Sharma & Ganguly 2005).
Very severe outbreaks may have symptoms that include swollen and tender lymph glands in the groin, throat, or under the arms, and even flu-like feelings such as fever, chills, headache, and a general run down feeling.
Although rheumatic fever is becoming rare in the United States, problems do not arise until five to ten years after the fever occurs.
3) Is her history of rheumatic fever relevant to her current symptoms? Explain. Rheumatic fever caused by Group A Streptococcus bacteria may cause damage to heart tissues including valves. Overtime, congestive heart failure may have developed. However, the pulmonary semilunar valve seems to be the issue in this case study, whereas rheumatic fever normally affects left heart tissue.
People with JRA may experience chronic fever, anemia, joint pains, and heart, lungs, eyes, and nervous system concerns. They might experience them for some weeks. It is the arthritis flares that frequently return. However, some of the symptoms could be less intense in the subsequent attacks. Symptoms of JRA may be eye inflammation, pink rashes that appear and disappear, joint stiffness, swelling and pain, and recurring fevers with a temperature of 103 degrees or higher. They might also experience a decreased level of activity, deterioration of fine motor skills, impaired bone growth and development, and limping.
Streptococcus pyogenes, also known as Group A streptococcus (GAS), is a β-hemolytic, Gram-positive bacterium that most commonly causes respiratory disease, including pharyngitis or tonsillitis, as well as skin infections such as impetigo and cellulitis. The organism is transmitted via respiratory droplets or by contact with fomites, and commonly infects young children. In addition to the common clinical presentations associated with S. pyogenes, some individuals develop the postinfectious sequelae of rheumatic fever and glomerulonephritis. Due to the severity of these medical consequences, prophylactic antibiotic use is often recommended for any patients with otherwise mild S. pyogenes infections (21).
If a streptococcal infection such as pharyngitis or scarlet fever is left untreated, there is a small (~3%) chance that within approximately 20 days, the patient will present with rheumatic fever. After the first bout of rheumatic fever, if the host acquires a second untreated S. Pyogenes infection, the chance of coming down with rheumatic fever jumps substantially to ~50%. Most often this secondary disease will strike people aged 6-15 years old, roughly 20 days after the streptococcal infection, with a 2-5% mortality rate. One of the major diagnostic symptoms of this disease is Erythema Marginatum, snake- or ring-like eruptions covering the trunk, upper arms, and legs. Other symptoms include fever, arthritis (elbows, knees, wrists, and ankles), swollen joints, pain in the abdomen, nodules
Rheumatoid arthritis is a chronic syndrome that is characterized by inflammation of the peripheral joints, but it may also involve the lungs, heart, blood vessels, and eyes. The prevalence of this autoimmune disease is between 0.3% to 1.5% of the population in the United States (Feinberg, pp 815). It affects women two to three times more often than men, and the onset of RA is usually between 25 and 50 years of age, but it can occur at any age (Reed, pp 584). RA can be diagnosed by establishing the presence of persistent joint pain, swelling in a symmetric distribution, and prolonged morning stiffness. RA usually affects multiple joints, such as the hands, wrists, knees, elbows, feet, shoulders, hips, and small
A 32-year old nurse who has rheumatic fever as a child noticed a persistent tachycardia and light-headedness. Upon examination, chest x rays showed an enlarged left atrium and left ventricle. ECG analysis showed atrial fibrillation. There was also mild pulmonary congestion. Cardiac evaluation resulted in the following information:
Acute tonsillitis is inflammation of the tonsils secondary to an infectious process causing painful swallowing and is more commonly attributed to a viral cause rather than bacterial (Shepherd, 2013). A physical assessment of the tonsils may reveal an increase in size with edema and erythema. This is often associated with upper respiratory symptoms like, headache and cough (Shepherd, 2013). Another diagnosis is pharyngitis. Pharyngitis is also a sore throat which is secondary to inflammation noted at the back of the throat and associated with complaints of pain when swallowing (Shepherd, 2013). Viral pharyngitis is the most common and can be contributed to the rhino or coronavirus which lasts between 5-7 days and presents with associated symptoms like cough, headache, fatigue and mild fever (Ruppert & Fay, 2015). Finally, GABHS or more commonly noted as strep throat is a potential diagnosis. This bacterial infection is most common in children and adolescents. Often individuals present with symptoms including throat pain, fever, chills, headache, cervical lymphadenopathy and exudate noted to tonsils or in the pharyngeal (Ruppert & Fay, 2015). This infectious process in younger children may also present with gastrointestinal symptoms like nausea, vomiting and abdominal pain but is not accompanied by cough or nasal
Rheumatic fever is a disease that can occur following an infection caused by the Group A streptococcus bacterium. If untreated, an infection such as ‘strep throat’ may lead to a delayed complication featuring widespread inflammation in other parts of the body, particularly the joints, heart, skin and brain.
Hospital records were examined, and those with diagnosed RS with the precedent viral illness were selected as cases. In these studies, school classmates were matched as controls based upon age, sex, and antecedent of illness. Second, an additional study conducted in Michigan examined the relationship between juvenile rheumatoid arthritis and RS. Cases were selected via medical records from the Division of Diseases Surveillance at the Michigan Department of Public Health between 1982 and 1983. Those with juvenile rheumatoid arthritis, long-term aspirin therapy, and RS were compared to cases ex RS. In 1982, an animal study examined RS symptoms in ferrets, aspirin ingestion, and an arginine deficient diet. This experimental study was divided into eight groups, differing between a control, influenza, aspirin, and arginine diet and the combination of exposures. Another study examined medical records from the Royal Alexandra Hospital for Children in Sydney, Australia for cases of RS. The population was examined for detailed medical records and the Centers for Disease Control case definition of RS. Lastly, an additional study in Australia compared cases of RS to controls matched for age, date seen at the hospital, and symptoms. Noted there are countless other studies, commentaries, and reviews regarding RS and aspirin, these are just a
“Streptococcus is a bacteria that infects the Immune System. The Immune System is made up of a network of cells, tissues, and organs that all work together to protect the body”("Immune Response"). According
J.F is a fifty-year-old married homemaker. She suffers from recurrent bacterial endocarditis secondary to a genetic autoimmune deficiency. In the last six-teen months she has been hospitalized twice, once for Staphylococcus Aureus infection in the mitral valve and then for Streptococcus Mutans
In the case of Martha, she had an episode of rheumatic fever in her twenties. Rheumatic fever, of which is an illness brought on by Streptococcus A, produces a protein that attaches to the cell wall of an organism causing inflammation. This can affect the heart and cause pancarditis, which is an infection of the entire heart. Endocarditis is the portion of pancarditis that causes valvular disorders. Though the pulmonic valve is not commonly affected, it is still a possibility. The valve apparatus can become fused leading to stenosis years after a rheumatic fever episode that is acute, and damage can become progressive if there are subsequent episodes (Chin, 2014). With Martha 's murmur being low in pitch and more of a rumbling, it is considered a narrowing of the valve or stenosis. The murmur is located left of the sternal border and in the upper portion. This is the pulmonic valve region, which would make this a pulmonic valve stenosis (Rao, 2014). According to Rao (2014), the murmur is due to the leaflets of the pulmonic valve not completely opening. This causes a resistance of the blood flowing foward through the valve, which happens during systole of the ventricles. This further causes a turbulence of the blood and makes the sound of the murmur. Pulmonic valve stenosis can then lead to ventricular hypertrophy of the right ventricle, which is proportional to how obstructed the valve becomes (Rao, 2014).