Pathogenesis of RHD

The route of RHD infection is usually through the gut and once the virus gains entry, it targets hepatocytes and cells of the mononuclear phagocytic system such as Kupffer cells, circulating monocytes and alveolar macrophages and endothelial cells (Ramiro-Ibáñez 1999, Neimanis et al. 2018). Replication within the cytoplasm of hepatocytes causes acute necrotising hepatitis. Disseminated intravascular coagulation ensues and can produce fibrinous thrombi within small blood vessels in most organs, notably the lungs, heart and kidneys resulting in haemorrhages. Death is due to disseminated intravascular coagulopathy or to liver failure.