Acute rheumatic fever: presentation and diagnostic criteria
THE CONTEXT
Acute rheumatic fever is a multisystem disorder that typically presents after streptococcal pharyngitis. Diagnosis combines clinical manifestations with evidence of preceding infection, with specified exceptions.
Clinical presentation
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Typical symptoms are fever, anorexia, lethargy and joint pain, occurring 2–3 weeks after streptococcal pharyngitis.
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A preceding sore throat may not be recalled.
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Arthritis occurs in approximately 75% of patients.
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Other manifestations include rashes, subcutaneous nodules, carditis and neurological changes.
Revised Jones criteria
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Diagnosis requires two or more major manifestations, or one major and two or more minor manifestations, together with evidence of preceding streptococcal infection.
Special diagnostic situations
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A presumptive diagnosis can be made in isolated chorea or pancarditis without evidence of preceding streptococcal infection, provided other causes have been excluded.
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In patients with established rheumatic heart disease or prior rheumatic fever, multiple minor criteria together with evidence of preceding group A streptococcal pharyngitis can establish the diagnosis.