Aschoff giant cells (large vesicular with prominent central nucleolus appearing in cross section as owl eye

Aschoff nodule

Anitschkow cells with an elongated nucleus.

Lesions of acute rheumatic fever

Heart

Joints

Skin

CNS

Endocarditis

1. Heart Affection

Pericarditis

Myocarditis

Acute rheumatic fever,schematic

Aschoff nodule

Aschoff giant cells

Aschoff cells

Acute rheumatic vegetation

Normal valve

Diseased valve

Fibrinous pericarditis, bread and butter appearance

Fibrinous pericarditis, bread and butter appearance

Firinous pericarditis

Strands of fibrin

2- Rheumatic Arthritis
Present in 80% of patients,

Polyarthritis, migratory preferring large joints as

elbows, knees, shoulders, ankles and wrists. Affected joints show cardinal signs of inflammation (red, hot, painful, swollen with loss of function. Good response to salisylates,

Complete recovery.

Knee

Arthritis

Elbow

4-Subcutaneous Nodules
Cutaneous lesion. Present in 9-20 % of patients, Usually 0.5-2cm firm non tender

nodules isolated or in clusters

Often on extensor surfaces of joints as elbows, knees and wrists. -Also bony prominances tendons, occiput or cervical spines. Last few days only.

Subcutaneous nodules

Subcutaneous nodules

A central area of fibrinoid necrosis surrounded by pallisading epithelioid macrophages. and other mononuclear cells

3- Erythema Marginatum
Cutaneous lesion.

Present in 7 % of patients,
Round or irregular shape

Reddish pink borders,

pale centre, Often on the trunk, abdomen, inner arms or thigh

Erythema marginatum

5.Sydenham's chorea
Involuntary purposeless jerky movement of the trunk and extremities due to involvement of basal ganglia of the brain. It usually develops 6 months after streptococcal pharyngitis.

It may persist for weeks with

excellent prognosis. Complete recovery.

Jones Criteria
Major criteria Carditis. Polyarthritis. Erythema marignatum. Subcutaneous nodules. Rheumatic chorea Minor criteria: Arthralgia. Fever, leucocytosis. Previous history of rheumatic fever. Increase C reactive protein or ESR ASO titre,

Erythema marginatum Subcutaneous nodule

Pan-carditis

Arthritis

Chorea

Chronic Rheumatic Valvilitis

Thick cusps of mitral valve

Thick shortened chorda tendineae

Chronic rheumatic valvulitis

Thick cusps of mitral valve

Thick shortened chorda tendineae

Chronic Rheumatic Valvilitis

Thick cusps of mitral valve

Thick shortened chorda tendineae

Button hole orifice

Mitral stenosis

Fish mouth orifice

Chronic rheumatic valvilitis, mitral valbe

Fused commisure, narrow orifice (aortic valve

Aortic stenosis

Atrial thrombosis in case of mitral stenosis, opened left atrium

LEFT ATRIAL THROMBUS

ADHESIVE PERICARDITIS

Pathophysiology
1. Turbulent blood flow abnormal blood flow
associated with underlying cardiac defect

disrupts the endocardium. 2. Bacteremia delivers the organisms to the endocardial surface 3. Adherence of the organisms to the endocardial surface 4. Eventual invasion of the valvular leaflets

Normal mitral valve

Infective endocarditis (mitral valve)

Infective endocarditis (mitral valve) on top of chronic rheumatic valvulitis

Normal aortic valve

Infective endocarditis (aortic valve)

Infective endocarditis oartic

Heart, infective endocarditis of the tricuspid valve - opened right atrium

Local Spread of Infection

Acute S. aureus IE with perforation of the aortic valve and aortic valve vegetations.

Acute S. aureus IE with mitral valve ring abscess extending into myocardium.

Infective mitral valve vegitation

Platelet / fibrin mass

Bacterial colonies

Infective endocarditis (pyamic abscesses)

Pin point yellow microabscess scattered on epicardial surface

Pin point yellow microabscess scattered on epicardial surface (pyamic absceses)

Micro abscess: centre: blue bacterial colony surrounded by

inflammatory cells

Microabscesses (pyamic abscesses)

Pyamic abscesses (liver)

Petechiae, nonspecific,often located on extremities

or mucous membranes

Peticheal Hge from septic emboli

Splinter hemorrhage from septic emboli

Finger clubbing

Normal glomerulus

Acute diffuse proliferative G.N

Acute diffuse P.G.N

Non bacterial thrombotic endocarditis, the valve is normal

Non bacterial thrombotic endocarditis