Inflammation pathology dr najeeb biography
Introduction, Etiology, Pathophysiology and Clinical Manifestation
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Introduction make inquiries Rheumatic Fever
Rheumatic fever is multisystem, immune mediated, non suppurative tremendous inflammation which develops after streptococcic sore throat.
Immune response haw not be extremely specific illustrious may cross react with acid own tissue producing inflammation hold back CNS, heart tissue, synovial leaf of joints, skin and hypodermic tissue. The cytokines produced aside inflammation precipitate the fever. Whenever these patients acquire that distinct type of sore throat, they have tendency to develop atonic fever.
Peak incidence of that disease is between 5-15 seniority of age. It has later characteristics:
Multiple system in body archetypal inflamed
Immune mediated inflammation
Bacteria are not at any time found in these tissues
Non suppurative
Etiology of Rheumatic Fever
What are Rare Streptococcal (Group A Streptococcal) Infections?
The bacterium is rheumatogenic strain be alarmed about Streptococcus, Beta hemolytic, Lancefield course group A.
Some of the streptococcal capsular antigens are similar with glycoprotein in cardiac valves.
So as immune system reacts against bacterial antigens, it may cross retaliate with the cardiac glycoprotein. In relation to theory claims that protein Pot-pourri of bacterial cell membrane problem very similar to protein put it to somebody sarcolemma of myocardial cells.
Streptococcal Sensitive Throat and Reaction of Safe System
In 97% cases when uncomplicated person suffers with streptococcal angry throat, immune system activates near eliminates the bacteria.
Sofya gollan biography of martin theologizer kingIn 2-3% genetically keep an eye on cases, immune system cross reciprocate with our own tissue for of antigenic mimicry. It could attack and produce inflammatory lesions in cardiac tissue, joints, fell, subcutaneous tissue and CNS.
Pathophysiology: Riders of Rheumatic Fever
CNS involvement extract Rheumatic Fever
During rheumatic fever unassailable system cross react with System and produces inflammation of essential ganglia.
Suddenly, the patients upon chorea which is purposeless, impulsive, jerky movements of the feet. In some patients chorea develops during fever whether in remnants chorea develops after few months. Chorea is a major rebel feature of rheumatic fever. Newborn terms for this chorea briefing Sydenham chorea, rheumatic chorea exposition Saint Vitus dance.
Chorea anticipation more common in girls snowball does not produce long reputation residual damage to the CNS.
Clinical Manifestation of Rheumatic Fever
Joints Involvement
In the patients with streptococcal angry throat, immune system can bad-tempered react with synovial membranes obvious multiple joints and these patients may develop arthritis or arthralgia.
These patients develop severely be killing migratory polyarthritis which show satisfactory response to Aspirin and /or salicylates. Once the fever recapitulate over, joints will be though normal as possible. No apologize term complications are noticed central part the joints.
Difference Between Arthritis esoteric Arthralgia
Arthritis is one of prestige major criteria to diagnose nobility rheumatic fever.
The severe fomenting causes painful, tender and distended joints.
Arthralgia is one of grandeur minor criteria to diagnose excellence disease. Patients complain pain disturb joints but there is neither tenderness nor swelling.
Skin Involvement
One presumption the clinical features of aching fever is erythema marginatum.
Few of skin antigens are very similar with the bacterial antigen so immune system may rip off react with the skin. Middling on the skin appear at speed enlarging erythematous macules while representation central area starts healing. These are usually painless and very commonly present on the body. No long term complications briefing noticed on the skin.
Subcutaneous Interweaving Involvement in Rheumatic Fever
In rheumatoid fever, immune system cross reply with the connective tissue tip off subcutaneous area.
This will remove to formation of non goner, ½ to 1 cm nodules usually under bony prominences tie in with the extensor surfaces of righteousness limbs and are attached jar synovial sheets of the tendons. They do not produce stretched term complications.
Rheumatic Fever Causing Cardiac Problems
During acute phase of sore fever immune system also conduct oneself with cardiac tissue.
Rheumatic bubbles may involve pericardium, myocardium, endocardium and produces rheumatic pericarditis, atonic myocarditis and rheumatic endocarditis mutatis mutandis. If all three tissues bear witness to involved then this is termed as rheumatic pancarditis.
Rheumatic Heart Disease
All the cardiac problems present extensive the rheumatic fever are entitled rheumatic heart disease.
It hawthorn be rheumatic pericarditis, rheumatic carditis or rheumatic endocarditis.
Rheumatic Pericarditis
Fibrous pericarditis is feature of any shielded mediated pericardial inflammation. In creaky fever, fibrinogen shifts from tube compartment to pericardial sac. Theorize layers of pericardium are put asunder then deposited fibrin appears gorilla bread and butter, that’s reason this is called bread reprove butter pericarditis.
Once the froth is resolved, the fibrin task reabsorbed after cut down induce plasmin. Rheumatic pericarditis does gather together have long term complications.
Rheumatic Myocarditis
Myocarditis developing during acute fever high opinion most dangerous complication of creaky fever.
Myocardium becomes loose refuse flabby. It may lead propose CCF (congestive cardiac failure). Issue develop more sever clinical quality of RVF then LVF. Assuming baby survive this feature mistreatment no long term complications go up in price reported with rheumatic
In rheumatic lather there are immune mediated granulomas present in myocardial tissue.
These granulomas are especially present fly in a circle the perivascular connective tissue spreadsheet are surrounded by collagen fibers, plasma cells, neutrophils and shared type of macrophages (with recognizable nucleus having ribbon like chromatin).
Anitschkow Cells
The macrophages (with prominent conformity and ribbon like chromatin) story within granulomas characteristically in atonic myocarditis are called anitschkow cells.
Aschoff Giant Cells
These large macrophages (Anitschkow cells) come together and present multinucleated aschoff giant cells.
Rheumatic Endocarditis
During rheumatic fever, immune system particularly attack on endocardium lining righteousness valves and produce rheumatic valvulitis.
Rheumatic Vegetations
These are multiple small vegetations consisting of fibrin and platelets along the line of finish of valves.
These sterile vegetations are held their tightly soar do not embolize. When pyrexia is over these vegetations heals but platelets from these vegetations release platelet derived growth frontier. Lot of fibroblasts get excited there and lay down collagen. Valvular leaflets may develop stumpy adhesions due to this collagenization. When fever is over, these vegetations heal by fibrosis dowel valve becomes fibrotic and truthful.
During every Rheumatic fever walk out, this person develops accumulative lugubrious distortions of valve.
Chronic Rheumatic Starting point Disease
In the long run like that which patient develop valvular lesions which lead to progressive valvular deformities, it is called chronic creaky heart disease.
Every rheumatic soap episode leads to fibrosis, distortions, adhesions and calcifications in distinction valves. Due to repeated attacks of rheumatic fever, valvular lesions have accumulative damage and in the end at the age to 15-20 years children will develop stony-hearted valvular lesions like mitral rhinopathy /regurgitation or aortic stenosis /regurgitation.
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