Rheumatic fever

Rheumatic fever is an infection caused by group A beta haemolytic streptococci (strep pyogenes

Diagnosis is by the revised Jones criteria, which is: 
  • evidence of preceding streptococcal infection
  • throat culture positive for bacteria
  • positive rapid antigen detection test result
  • elevated antistreptolysin O titre 
  • scarlet fever 
  • chorea 
  • 2 major criteria OR 1 major and 2 minor criteria 

Major criteria: 
  • carditis 
  • polyarthritis 
  • chorea 
  • erythema marginatum 
  • subcutaneous nodules 

Minor criteria: 
  • long PR 
  • fever
  • arthralgia 
  • Raised ESR/CRP 

  • bed rest 
  • aspirin 
  • penicillin (or erythromycin if penicillin allergic) 
  • possibly surgery if severe MR 
  • prophylactic penicillin IM once monthly 
    • for 5 years if acute rheumatic fever 
    • OR until age 18 without proven carditis 
    • OR 10yrs or until aged 25 if mild MR 
    • OR lifelong if severe valve disease 

  • 60% of patients develop rheumatic heart disease, most commonly of the mitral valve 
  • 10% recurrence of acute rheumatic fever within 5 years if no prophylaxis. 

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