Pathology: Systemic inflammatory disease occurring 2-4weeks after pharyngeal infection
with group Abeta haemolytic Streptococcus pyogenes
Aetiology: Autoimmune antibody-antigen complex whichwere produced against the Streptococcus
pyogenes cell wall and proteins on cardiacvalves. It affects heart, joints, skin and brain. Peak age 5-15 years
Symptoms: Polyarthritis,heart failure, fever, joint pain, involuntary movements, sore throat
Signs: Symptoms of valvedysfunction, subcutaneous nodules, erythema marginatum,
Investigations: Bloods: FBC, CRP, Anti-streptolysin O titre, DnaseB titre
Throatswab: screens for pharyngitis
ECG: Prolonged PR
Echo: Assesses valvular and LV function
Histology: Aschoff Bodies:Granulomatous nodules with central necrosis and
fibrinoid degeneration with a cuff of macrophages
Anitschkow Cells: Altered macrophages within Aschoff Bodies with
ribbon like chromatin pattern with thenuclei
Diagnosis: Based on the JonesCriteria. Positive throat swab for Group A Beta
Haemolytic Streptococcus or Elevated anti-streptolysinO titres + 2
major criteria or 1 major and 2 minor criteria
Treatment: Acute: Bed rest, analgesia and antibiotics (single dose of IMbenzylpenicillin
otherwise oral penicillin or macrolidefor 10 days.
Symptom Control: NSAIDs or Aspirin forpancarditis or arthritis, however
NSAIDs can exacerbate heart failure.
Chorea can be treated with haloperidolor diazepam
Complications: If untreated progresses to rheumaticheart disease leading to valvular disease
Prognosis: 60% with carditis develop chronicrheumatic disease or valve dysfunction.
Initial mortality is 1%.
