Rheumatic fever is a disease that can occur following a group A streptococcal bacterial infection. Predisposing infections also include streptococcal tonsillitis and skin infections, such as impetigo, caused by Streptococcus pyogenes. Overall, rheumatic fever is rare in Australia; however, the rate of rheumatic fever among indigenous Australians is much higher. Rheumatic fever is a serious condition that can lead to long-term complications, such as rheumatic heart disease. Causes and Pathophysiology Most commonly, rheumatic fever occurs following a group A streptococcal tonsillitis infection of the throat. It may also follow skin infections caused by the same organisms; this is especially true for many indigenous Australians. Symptoms of rheumatic fever can take up to a month to develop after the initial infection. Rheumatic fever is an acute infection with an interesting pathogenesis. It is the result of the immune system producing antibodies to fight group A streptococcal infection. Rheumatic fever is a type II hypersensitivity reaction, which means that antibodies produced by the immune system bind to antigens present on body tissues and cause a response. Group A streptococcal organisms have 3 predominant virulence factors that help establish an infection: 1. M proteins: M proteins are found on the surface of the organism and protect it from phagocytosis. M proteins prevent the attachment of complement proteins to the cell. Complement proteins that are attached to the bacterium “mark” it for destruction by phagocytic cells, such as neutrophils and macrophages, in a process called opsonization. By inhibiting this process, the M protein allows group A streptococcus to survive longer...... middle of paper ......essBlood tests performed when post-streptococcal glomerulonephritis is suspected are similar to those discussed above for fever rheumatism. In this condition, blood pressure is often elevated and should also be measured. A urine sample may also be tested to aid in diagnosis. The main treatment for post-streptococcal glomerulonephritis involves a course of antibiotics (usually penicillin) to kill the remaining group A strep. Diuretics may also be prescribed to reduce the amount of fluid in the body and therefore the amount of swelling. These can also help control blood pressure, and in some cases other blood pressure medications may also be used. Unlike rheumatic fever, preventative antibiotic injections are not given to patients with post-streptococcal glomerulonephritis because it is rare for the infection to occur more than once.