Tips: What is rheumatic fever?

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(1) The collagen fibers in the connective tissue split and swell during the degeneration and exudative phase , forming hyaline and cellulose-like degeneration.

Bleeding collagen fiber swelling lymphocytes plasma cells neutrophil infiltration

(2) The proliferative phase is characterized by the appearance of rheumatic granuloma or rheumatic corpuscles (Aschoffbody) on the basis of the above-mentioned lesions .

Proliferation of granuloma pathological necrosis basophilic nuclei nucleolus multinucleated giant cells

(3) The degenerative and necrotic material in the center of the upper body of rheumatism during sclerosis is gradually absorbed, the exuded inflammatory cells are reduced, fibrous tissue proliferates , and scar tissue is formed at the granuloma site .

Fibrous hyperplasia scar tissue

Because the disease often recurs, the development process of the above three phases can be staggered, which lasts about 4 to 6 months.

Symptoms pericardial scar endocardium myocardium

The inflammatory lesions of rheumatic fever involve the collagen fibers of the connective tissues of the whole body.

Pericarditis machine of

The pathological changes of each organ tissue are as follows:

Organ tissue

1.

Pancarditis, myocarditis, endocarditis, rheumatism, vascular congestion, neoplasm, fibrin tendons, papillary muscle, pericardial cavity

After the active period, lighter patients may fully recover, but in most patients, it causes heart valve deformation and myocardial or intrapericardial scar formation, resulting in chronic inactive heart disease , and heart valve disease is the most significant.

Heart disease, valve defect, mitral valve stenosis, aortic valve stenosis

2.

Synovial edema malformation sequelae

3.

Signs of rheumatic activity of basal cell nodules

4.

Arterial Thrombosis Coronary Mesenteric

5.

Alveolar small vessels

6.

Substantia nigra cerebral cortex

Others such as rheumatic pleurisy and peritonitis can occasionally occur.
　　

Pleurisy peritonitis

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Acute rheumatism can occur at any age, but it is extremely rare in infants and young children under 3 years old, and is most common in children and adolescents between 5 and 15 years old .
The chances of men and women getting sick are roughly equal.
The recurrence is mostly within 3 to 5 years after the initial onset, and the recurrence rate is as high as 5% to 50%, especially those with heart involvement are prone to relapse.
Epidemiological studies have shown that, on average, about 3% of patients develop acute rheumatic fever after streptococcal pharyngitis.
The age at which acute rheumatic fever is susceptible, regional distribution, incidence and severity are the reflections of the incidence and severity of streptococcal infection.
After streptococcal infection, the incidence of acute rheumatism is directly related to the degree of immune response caused by group A streptococci .
Various environmental factors (geography, humidity, season, etc.
), economic status, and age can affect the incidence of rheumatic fever.

Childhood morbidity immune response

The prevalence of rheumatic fever and rheumatic heart disease has dropped significantly in the past 30 years, which is closely related to the improvement of socio-economic conditions (housing and economic conditions) and the adoption of extensive preventive measures.
my country is higher in Northeast and North China, followed by East China, Central China, Southwest and Northwest China, and less in South China.
The attack season is mostly cold winter and early spring.
Cold and humid are important predisposing factors for this disease.
The percentage of acute rheumatic fever in medical inpatients has dropped from 2.
49% in 1958 to 0.
86% in recent years.
In the Zhongshan Hospital and Huashan Hospital of Shanghai Medical University from 1948 to 1957, from 1958 to 1968 and from 1969 to 1979, the proportions of hospitalizations of various causes of heart disease were analyzed three times .
The disease accounted for 50.
3%, 40.
8% and 29.
95%, respectively.
It can be seen that this disease is still a disease that must be actively prevented in our country .
　　

Prevalence rate medical composition ratio disease

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Most patients have a history of upper respiratory tract infection such as pharyngitis or tonsillitis 1 to 5 weeks before onset .
At the onset of illness, the whole body was tired, appetite decreased , and irritability.
The main clinical manifestations are: fever, arthritis, carditis, subcutaneous nodules, annular erythema and chorea.

Pharyngitis Tonsillitis Respiratory tract infection Loss of appetite Ring erythema

(1) Fever Most patients have irregular mild or moderate fever, but there are also flaccid fever or persistent low fever.
Increased pulse rate and sweating a lot, often out of proportion to body temperature .

Relaxation fever

(2) The typical manifestation of arthritis is migratory polyarthritis, often symmetrically involving the knee, ankle, shoulder, wrist, elbow, hip and other large joints; local inflammation, swelling, heat, and pain, but not purulent .
In some patients, several joints occur at the same time, and small joints of the hands, feet, or spine joints can also be affected.
It usually occurs within one month after streptococcal infection, and the titer of anti-streptococcal antibodies can often increase.
After the acute inflammation subsides, the joint function is completely restored, no joint stiffness and deformity are left , but the recurrence often occurs.
The typical is rare in recent years.
The degree of local joint inflammation has no obvious relationship with the presence or absence of carditis or heart valve disease.

Suppurative spinal anti-streptococcal antibody titer acute inflammation joint ankylosis

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Anti-rheumatic treatment  Aspirin is used for arthritis, fever and mild myocarditis, starting from 80mg to 100mg/kg.
d in divided doses.
After 2 to 3 weeks, 40mg-50mg/kg.
d, the total course of treatment is 6-12 weeks.
For those with obvious carditis, congestive heart failure, or aspirin ineffective, give prednisone 1.
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d in divided doses.
After 4 weeks, reduce the amount by 1/3 every 3 days.
The total course of treatment is 6 weeks; Decrease the hormone and give aspirin 50 mg/kg.
d at the same time, and stop the drug after 8 weeks.
For severe myocarditis with heart failure, intravenous dexamethasone can be used.

Aspirin prednisone

4.
Treatment of chorea Chorea is a self-limiting disease , and sedatives such as luminal and diazepam can be used.

Self-limiting disease leave a message here