Acute Rheumatic Fever and Sydenham's Chorea

Posted by e-Medical PPT Wednesday, September 29, 2010
Rheumatic fever is an inflammatory disease that occurs following a Group A streptococcal infection.Believed to be caused by antibody cross-reactivity that can involve the heart, joints, skin, and brain, the illness typically develops two to three weeks after a streptococcal infection.This cross-reactivity is a Type II hypersensitivity reaction and is termed molecular mimicry. Acute rheumatic fever commonly appears in children between the ages of 5 and 15.According to revised Jones criteria, the diagnosis of rheumatic fever can be made when two of the major criteria, or one major criterion plus two minor criteria, are present along with evidence of streptococcal infection.

Major criteria
* Migratory polyarthritis
* Carditis: inflammation of the heart muscle which can manifest as congestive heart failure with shortness of breath, pericarditis with a rub, or a new heart murmur.
* Subcutaneous nodules: painless, firm collections of collagen fibers over bones or tendons.
* Erythema marginatum
* Sydenham's chorea (St. Vitus' dance)

Minor criteria
* Fever
* Arthralgia: Joint pain without swelling
* Raised Erythrocyte sedimentation rate or CRP
* Leukocytosis
* ECG showing features of heart block, such as a prolonged PR interval
Supporting evidence of Streptococcal infection: elevated or rising Antistreptolysin O titre.

Sydenham's chorea is a disease characterized by rapid, uncoordinated jerking movements affecting primarily the face, feet and hands.The disease is usually latent, occurring up to 6 months after the acute infection.SC is more common in females than males and most patients are children, below 18 years of age.SC is characterised by the acute onset of motor symptoms, classically chorea, usually affecting all limbs. Other motor symptoms include facial grimacing, hypotonia, loss of fine motor control and a gait disturbance.

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