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6: Rheumatic Fever - Etiology, Clinical features Diagnosis, and Treatment | Pathology USMLE Step 1
Explore the comprehensive pathology of rheumatic fever tailored for USMLE Step 1 preparation. Rheumatic fever, an autoimmune inflammatory disease, typically arises as a sequela to untreated or inadequately treated group A Streptococcal pharyngitis. The etiology involves molecular mimicry, where antibodies against streptococcal antigens cross-react with self-antigens, leading to immune-mediated damage to various tissues, including the heart, joints, skin, and central nervous system. Clinical features manifest as migratory polyarthritis, carditis (with manifestations such as pancarditis, including endocarditis, myocarditis, and pericarditis), subcutaneous nodules (Aschoff bodies), erythema marginatum, and Sydenham chorea. Diagnosis relies on the Jones criteria, which encompass major criteria (carditis, arthritis, chorea, subcutaneous nodules, erythema marginatum) and minor criteria (fever, arthralgia, elevated acute-phase reactants). Treatment involves antibiotics to eradicate streptococcal infection, anti-inflammatory medications (e.g., aspirin, corticosteroids) to alleviate symptoms and prevent carditis progression, and secondary prophylaxis with penicillin to prevent recurrent attacks and rheumatic heart disease development. Understanding the multifaceted etiology, varied clinical presentations, diagnostic criteria, and management strategies of rheumatic fever is paramount for medical students preparing for board exams and future clinical practice. 📚
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