1. 2.) What is the Pathophysiology of Rheumatic Fever/ Rheumatic Heart Disease?

2. Organism Factors Based on evidence, ARF is exclusively caused by URTI ( Group A Streptococci). It has been postulated that a series of preceding streptococcal infections is needed to “prime” the immune system to the final infection that directly causes the disease.

3. The Immune Response Susceptible host encounters a group A streptococcus Auto immune reaction occurs Leads to human tissue damage as a result of cross-reactivity between epitopes on the organism and host.

4. Molecular mimicry Group A Streptococci- has epitopes present in the M protein Similar molecules – human myosin, tropomyosin, keratin, actin, laminin, vimentin, and NAG. Basis for Autoimmune response T cell sensitization T cells recalled following subsequent exposure

5. Valvular Damage Laminin- found in cardiac endothelium and is recognized by anti-myosin, anti-M protein, T cells. Antibodies to cardiac valve cross react with NAG

6. 4.) What is the differential Diagnosis for the cause of Fever?

7. Infective Endocarditis Prototypic lesion- vegetation Infection most commonly involves the heart valve Organisms that cause this generally enter the bloodstream from mucosal surfaces, the skin, or sites of focal infection.

8. Infective Endocarditis Etiologies: – Health Care Associated – bacteremia arising from IV catheterizations, nosocomial wound, UTI’s, chronic invasive procedures – Prosthetic Valve endocarditis- intraoperative contamination – Injection drug users-

9. Infective Endocarditis Highly variable clinical manifestations Causative microorganism primarily responsible for acute course incluse B-hemolytic streptococci, S. aureus, and Pneumococci. Febrile patient with valvular abnormalities or behavior pattern that predispose ( injection drug use) Bacteremia with organisms that frequently causes endocarditis

10. Infective Endocarditis 39.4-40 degrees Celcius fever for the acute course Fever may be blunted or absent in patients who are elderly or severely debilitated.