Sue Case Study: Pathophysiology and Management of Acute Rheumatic Fever

Running Head: SUE CASE STUDY
Sue case study
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SUE CASE STUDY 2
Introduction
The paper intends to analyse Sue case. She is suspected to be suffering from acute
rheumatic fever. The purpose of the paper is to focus on how nurses should intervene. The
paper is divided into two sections. The first section will focus on the pathophysiology of
acute rheumatic fever and the second section will focus on the elements to consider during
the management of the acute rheumatic fever.
Pathophysiology of Acute Rheumatic Fever
Acute rheumatic fever (ARF) is the consequence of an autoimmune reaction that
occurs after pharyngeal Streptococcus pyogenes infection. The antigenic mimicry between
certain bacterial surface proteins - specific epitopes - and the cells of the host is at the origin
of a cross-immunological reaction occurring on a genetically predisposed terrain. In other
words, Streptococcus M proteins share epitopes (antigenic determinants recognized by Ac)
with synovial proteins, cardiac muscle, heart valves, indicating that molecular mimicry
contributes to the occurrence of arthritis, carditis, lesions valvular (Lennon, 2018). The role
of genetic factors is evidenced by the higher prevalence of acute rheumatic fever and chronic
rheumatic heart diseases (including rheumatic heart diseases) in individual families. In 75-
100% of patients and only 15% of healthy people on B-lymphocytes, there is a specific
alloantigen 883 (D8 / 17), detected with the help of special monoclonal antibodies (Zühlke, et
al 2017). The joints, the heart, the skin and the central nervous system are most often
involved. The pathology varies according to the site.
Concerning the joint, it is important to note that joint involvement resembles
nonspecific inflammation on a synovial biopsy specimen, sometimes with small foci
suggestive of Aschoff bodies (nodules found in the hearts of individuals with rheumatic
fever) (Lennon et al 2017).

SUE CASE STUDY 3
Concerning the heart, cardiac involvement is manifested as carditis, which usually
affects the heart from the inside to the outside, i.e. valves and endocardium, then the
myocardium and finally the pericardium. Characteristic and potentially dangerous valvular
abnormalities may occur. Acute interstitial valvulitis can cause valve edema. If left untreated,
it can lead to edema, thickening, retraction or other destruction of valves and cusps causing
stenosis or valve insufficiency (Kostopoulou, Gkentzi, Karatza & Dimitriou, 2018).
Similarly, tendinous cordage may shorten, thicken or weld, which may increase the
insufficiency of damaged valves or cause valve failure even in the absence of injury (Hanson-
Manful, et al 2018). The dilatation of the valvular rings may also cause regurgitant
insufficiency. The mitral valves are most often affected then the aortic, tricuspid and
pulmonary valves in order of decreasing frequency. Valvar insufficiency and narrowing
usually result from mitral and tricuspid valve lesions (Umapathy & Saxena, 2018).
Concerning the skin, the subcutaneous nodules are indistinguishable from those of
rheumatoid arthritis, but on the biopsy they look like Aschoff nodules (Bozabali, Bayraktar &
Kocabaş, 2017). The erythema marginé differs histologically from other skin lesions of
similar macroscopic appearance e. g, juvenile idiopathic arthritis rash, Henoch-Schönlein
purpura, chronic erythema migrans (manifestation of the onset of Lyme disease), and
erythema multiforme (Sato, Uejima, Suganuma, Takano & Kawano, 2017). At the level of
the dermis, perivascular infiltrates of neutrophils and mononuclear are found.
Initial symptoms usually occur nearly 2 to 4 weeks after streptococcal infection. The
manifestations typically involve an association of the joints, the heart, the skin and the central
nervous system. The migratory arthritis is the most common symptom, seen in about 70% of
children; it is often accompanied by fever. Sometimes, a monoarthritis is observed. The joints
are painful, sensitive, red, hot and accompanied by edema (Khanna & Liu, 2016). The ankles,
knees, elbows and wrists are the joints most frequently affected. The shoulders, hips and