Materiały źródłowe

• #1 Azthena logo with the word Azthena

  https://www.news-medical.net/health/How-is-Rheumatic-Fever-Diagnosed.aspx

  Rheumatic fever represents an autoimmune disease following infection with group A streptococcus (Streptococcus pyogenes), one of the most ubiquitous human pathogens. […] Rheumatic fever remains one of the major causes of childhood cardiac disease in developing nations and a serious public health problem worldwide. Hence, adequate diagnosis and management are of utmost importance, as damage to cardiac valves may be chronic and progressive, resulting in cardiac decompensation. […] The diagnosis of acute rheumatic fever is established based on identifying major and minor clinical manifestations of the disease, as detailed by the Jones criteria. […] Evidence of a recent streptococcal infection with at least two major manifestations, or one major and two minor manifestations present, is necessary to diagnose a primary episode of acute rheumatic fever.

• #2 Acute Rheumatic Fever – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK594238/

  Acute rheumatic fever (ARF) is an abnormal immunologic response to group A Streptococcus (GAS) infections, most commonly tonsillopharyngitis. […] Prompt diagnosis and treatment of ARF are essential in preventing complications and consequences of the disease. […] This activity for healthcare professionals is designed to enhance the learner’s competence in identifying the clinical features of ARF, performing the recommended evaluation, and implementing an appropriate interprofessional approach when managing this condition to optimize patient outcomes. […] Identify the clinical features of acute rheumatic fever. […] Select recommended diagnostic studies to evaluate patients with suspected acute rheumatic fever. […] The diagnosis of ARF is clinically based on the revised Jones criteria and typically presents within 2 to 4 weeks after an untreated GAS infection, most commonly GAS pharyngitis.

• #3 Rheumatic fever – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/rheumatic-fever/diagnosis-treatment/drc-20354594

  There’s no single test for rheumatic fever. Diagnosis of rheumatic fever is based on medical history, a physical exam and certain test results. […] Tests for rheumatic fever include: […] Blood tests can be done to check for signs of inflammation in the body. These tests include C-reactive protein (CRP) and the erythrocyte sedimentation rate (ESR), also called the sed rate. […] Another blood test can be done to look for proteins related to the strep bacteria. These proteins are called antibodies. […] This test shows how the heart is beating. It can help diagnose irregular heartbeats. A healthcare professional can check ECG signal patterns for signs of heart swelling. […] Sound waves are used to create pictures of the heart in motion. An echocardiogram shows the structure of the heart and how blood flows through it. […] It’s important to have regular health checkups after having rheumatic fever. Heart damage from rheumatic fever might not show up for many years even decades. Always tell your healthcare provider about any history of rheumatic fever.

• #4 Diagnosing Acute Rheumatic Fever | Group A Strep | CDC

  https://www.cdc.gov/group-a-strep/hcp/clinical-guidance/diagnosing-acute-rheumatic-fever.html

  There’s no definitive diagnostic test for acute rheumatic fever. […] A clinical diagnosis of acute rheumatic fever should be made using the 2015 revised Jones Criteria. […] Use the Jones criteria to make a clinical diagnosis of acute rheumatic fever. […] The presence of the following indicates a high probability of an initial acute rheumatic fever illness in any risk population: 2 major manifestations, 1 major and 2 minor manifestations. […] In some instances, a presumptive diagnosis of acute rheumatic fever can be made without fulfilling the Jones Criteria. […] A presumptive diagnosis of a recurrence can be made with any of the following: 2 major manifestations, 1 major and 2 minor manifestations, 3 minor manifestations. […] Routine echocardiography/Doppler is now recommended for all confirmed or suspected acute rheumatic fever cases.

• #5 Acute rheumatic fever diagnosis and management: Review of the global implications of the new revised diagnostic criteria with a focus on Saudi Arabia

  https://pmc.ncbi.nlm.nih.gov/articles/PMC6734099/

  Rheumatic fever (RF) diagnosis is clinical and based on revised Jones criteria. […] RF remains a diagnostic challenge for clinicians because of the lack of specific clinical or laboratory findings. […] The Jones criteria were revised in 2015 by the AHA, and the main modifications were as follows: the population was subdivided into moderate- to high-risk and low risk; the concept of subclinical carditis was introduced; and monoarthritis was included as a feature of musculoskeletal inflammation in the moderate- to high-risk population. […] The diagnosis of RF is based on Dr. Jones criteria, which were recently revised (2015). The criteria include major and minor manifestations, and risk stratification has recently been applied to populations, dividing them into low risk and moderate- to high-risk.

• #6 Rheumatic Fever: Causes, Symptoms, Treatment, Diagnostic Criteria

  https://www.medicinenet.com/rheumatic_fever/article.htm

  Rheumatic fever is an autoimmune disease that sometimes occurs after strep throat. […] There is no single diagnostic test for rheumatic fever, so the American Heart Association’s modified Jones criteria (first published in 1944 and modified in 1992) guide physicians in making the proper diagnosis. […] The revised Jones criteria are guidelines decided on by the American Heart Association to help doctors diagnose rheumatic fever. Two major criteria or one major and two minor criteria plus laboratory evidence of a preceding group A streptococcal (GAS) infection are required to make the diagnosis of rheumatic fever. […] The person must have a history of infection with group A streptococcal bacteria, either by laboratory documentation (for example, a positive rapid strep test) or positive strep culture, and must have two major or one major and two minor revised Jones criteria findings.

• #7 Jones Criteria for Diagnosis of Rheumatic Fever

  https://reference.medscape.com/calculator/278/jones-criteria-for-diagnosis-of-rheumatic-fever

  Diagnose acute rheumatic fever […] The diagnosis of acute rheumatic fever requires: 2 major, or 1 major and 2 minor manifestations, AND evidence of group A streptococcal infection […] Evidence of antecedent Strep infection: ASO / Strep antibodies / Strep group A throat culture / Recent scarlet fever / anti-deoxyribonuclease B / anti-hyaluronidase […] Major Diagnostic Criteria: Carditis, Polyarthritis, Chorea, Erythema marginatum, Subcutaneous Nodules […] Minor Diagnostic Criteria: Fever, Arthralgia, Previous rheumatic fever or rheumatic heart disease, Elevated acute phase reactant (ESR or CRP), Prolonged PR interval.

• #8 Rheumatic Fever: Causes, Symptoms, Treatment, Diagnostic Criteria

  https://www.medicinenet.com/rheumatic_fever/article.htm

  Rheumatic fever is an autoimmune disease that sometimes occurs after strep throat. […] There is no single diagnostic test for rheumatic fever, so the American Heart Association’s modified Jones criteria (first published in 1944 and modified in 1992) guide physicians in making the proper diagnosis. […] The revised Jones criteria are guidelines decided on by the American Heart Association to help doctors diagnose rheumatic fever. Two major criteria or one major and two minor criteria plus laboratory evidence of a preceding group A streptococcal (GAS) infection are required to make the diagnosis of rheumatic fever. […] The person must have a history of infection with group A streptococcal bacteria, either by laboratory documentation (for example, a positive rapid strep test) or positive strep culture, and must have two major or one major and two minor revised Jones criteria findings.

• #9 Azthena logo with the word Azthena

  https://www.news-medical.net/health/How-is-Rheumatic-Fever-Diagnosed.aspx

  Five manifestations are considered major manifestations of acute rheumatic fever: carditis, migratory polyarthritis, Sydenhams chorea, erythema marginatum, and subcutaneous nodules. […] It should be emphasized that the principal use of these diagnostic criteria is to help identify rheumatic fever. However, physicians maintain the right to diagnose this condition merely based on clinical judgment, even if the modified criteria are not completely satisfied. […] Acute phase reactants are useful in recognizing acute rheumatic fever and excluding other diseases. […] Laboratory evidence of inflammation and a preceding streptococcal infection should be documented either by demonstrating Streptococcus pyogenes in the throat by culture or using streptococcal antibody tests. […] Cardiac scanning scintigraphy has been shown to be a reliable technique to distinguish acute from chronic, inactive rheumatic heart disease, whereas endomyocardial biopsy should only be limited to clinical investigation due to its invasiveness. […] The role of echocardiography in diagnosing valvulitis without auscultatory findings has been debated.

• #10 Acute rheumatic fever: Clinical manifestations and diagnosis – UpToDate

  https://www.uptodate.com/contents/acute-rheumatic-fever-clinical-manifestations-and-diagnosis/print

  Acute rheumatic fever (ARF) is a nonsuppurative sequela that occurs two to four weeks following group A Streptococcus (GAS) pharyngitis and may consist of arthritis, carditis, chorea, erythema marginatum, and subcutaneous nodules. Damage to cardiac valves may be chronic and progressive, resulting in cardiac decompensation. […] The clinical manifestations and diagnosis of ARF are reviewed here. […] The possible major and minor manifestations are reviewed here. These manifestations are used for diagnosis (Revised Jones Criteria) (table 1). The diagnostic criteria are reviewed below. […] The five major manifestations (and percent of patients with each) are: Arthritis (usually migratory polyarthritis predominantly involving the large joints) – 60 to 80 percent.

• #11 Rheumatic Fever: A-to-Z Guide from Diagnosis to Treatment to Prevention | DrGreene

  https://www.drgreene.com/articles/rheumatic-fever

  Rheumatic fever is a serious inflammatory disease that can follow untreated or inadequately treated streptococcal infections. […] The diagnosis is based on specific symptoms called the Jones Criteria. To be diagnosed with rheumatic fever, someone must exhibit evidence of a recent strep infection along with 2 of the major criteria, or 1 of the major criteria and 2 of the minor criteria. […] Major criteria: Carditis (inflammation of the heart), Migratory polyarthritis (exquisite joint pain and inflammation), Chorea (involuntary movement of the limbs), Subcutaneous nodules (usually over the joints). […] Minor criteria: Fever (usually high), Arthralgia (joint pain, even in the absence of redness or swelling), Abnormal lab tests (sedimentation rate (ESR) or C-reactive protein (CRP), Abnormal electrocardiogram (EKG) (prolonged PR interval).

• #12 Jones Criteria for Diagnosis of Rheumatic Fever

  https://reference.medscape.com/calculator/278/jones-criteria-for-diagnosis-of-rheumatic-fever

  Diagnose acute rheumatic fever […] The diagnosis of acute rheumatic fever requires: 2 major, or 1 major and 2 minor manifestations, AND evidence of group A streptococcal infection […] Evidence of antecedent Strep infection: ASO / Strep antibodies / Strep group A throat culture / Recent scarlet fever / anti-deoxyribonuclease B / anti-hyaluronidase […] Major Diagnostic Criteria: Carditis, Polyarthritis, Chorea, Erythema marginatum, Subcutaneous Nodules […] Minor Diagnostic Criteria: Fever, Arthralgia, Previous rheumatic fever or rheumatic heart disease, Elevated acute phase reactant (ESR or CRP), Prolonged PR interval.

• #13 Acute rheumatic fever diagnosis and management: Review of the global implications of the new revised diagnostic criteria with a focus on Saudi Arabia

  https://pmc.ncbi.nlm.nih.gov/articles/PMC6734099/

  Rheumatic fever (RF) diagnosis is clinical and based on revised Jones criteria. […] RF remains a diagnostic challenge for clinicians because of the lack of specific clinical or laboratory findings. […] The Jones criteria were revised in 2015 by the AHA, and the main modifications were as follows: the population was subdivided into moderate- to high-risk and low risk; the concept of subclinical carditis was introduced; and monoarthritis was included as a feature of musculoskeletal inflammation in the moderate- to high-risk population. […] The diagnosis of RF is based on Dr. Jones criteria, which were recently revised (2015). The criteria include major and minor manifestations, and risk stratification has recently been applied to populations, dividing them into low risk and moderate- to high-risk.

• #14 Rheumatic fever – Symptoms, diagnosis and treatment | BMJ Best Practice US

  https://bestpractice.bmj.com/topics/en-us/404?locale=ar

  Currently, no single test can diagnose ARF. Diagnosis is clinical and relies on the Jones criteria. […] The Jones criteria were revised in 2015 to include separate criteria for low-risk and moderate- to high-risk populations and introduce the use of Doppler echocardiography to diagnose subclinical carditis. […] Diagnostic tests include erythrocyte sedimentation rate (ESR), CRP, WBC count, blood cultures, electrocardiogram, chest x-ray, echocardiogram, throat culture, rapid antigen test for group A streptococci, anti-streptococcal serology, and rapid molecular test.

• #15 Acute rheumatic fever diagnosis and management: Review of the global implications of the new revised diagnostic criteria with a focus on Saudi Arabia

  https://pmc.ncbi.nlm.nih.gov/articles/PMC6734099/

  To diagnose a patient with RF as a first episode of the disease, a confirmation of two major criteria or one major and two minor criteria is required, along with evidence of antecedent GAS infection. […] The evidence of GAS infection is confirmed by one of the following: a positive throat culture for GAS; increasing trend anti-streptolysin O titer (ASO) readings rather than a single titer result; or a positive rapid group A streptococcal carbohydrate antigen test in a child who clinically suggests a high pretest probability of streptococcal pharyngitis. […] The differences between low-risk and moderate- to high-risk populations in the major criteria are as follows. Arthritis must be polyarthritis in the low risk population, whereas in the moderate- to high-risk population it can be polyarthritis, polyarthralgia, and/or monoarthritis.

• #16 Rheumatic fever Identification, management and secondary prevention

  https://www.racgp.org.au/afp/2012/january-february/rheumatic-fever

  Initially described in 1944 by Jones, the diagnostic criteria for ARF separate the clinical features into major and minor manifestations major manifestations being more specific for the disease. The Jones criteria were last revised in 1992 to increase their specificity for ARF because the incidence in developed nations had decreased significantly. In 2006, the National Heart Foundation of Australia (NHFA) and the Cardiac Society of Australia and New Zealand (CSANZ) developed diagnostic and treatment guidelines for use in Australia, allowing for increased sensitivity among identified high risk groups. […] High risk refers to groups with high rates of ARF, such as Aboriginal and Torres Strait Islander communities living in rural or remote areas or in disadvantaged suburban areas. Sydenham (rheumatic) chorea is present in roughly 25% of Aboriginal Australians (especially female adolescents) with ARF. As part of the major manifestations, Sydenham chorea is sufficient to diagnose ARF without evidence of previous S. pyogenes infection, provided other causes of chorea have been excluded. The NHFA criteria consider some less specific symptoms, such as polyarthralgia and aseptic monoarthritis, to be major manifestations in high risk groups.

• #17 Acute Rheumatic Fever | Johns Hopkins ABX Guide

  https://www.hopkinsguides.com/hopkins/view/Johns_Hopkins_ABX_Guide/540006/all/Acute_Rheumatic_Fever

  Revised Jones Criteria (2015, AHA): for all w/ evidence of preceding GAS infection. […] Evidence of GAS preceding infection: required either Increased or rising ASO or anti-DNASE B titers. A rising titer is considered more reliable than a single titer result. […] Positive throat culture for GAS. […] Positive rapid GAS antigen test in a child with consistent clinical presentation. […] Initial ARF: 2 Major OR 1 Major and 2 Minor […] Recurrent ARF: 2 Major OR 1 Major and 2 Minor OR 3 Minor. […] WHO Criteria (2004): less stringent than Jones criteria. Chorea and indolent carditis do not require evidence of antecedent group A streptococcus infection. […] First episode per Jones criteria […] Recurrent episodes: If no established RHD: as per the first episode […] If established RHD: requires two minor manifestations, plus evidence of antecedent group A streptococcus infection. Evidence of antecedent group A streptococcus infection as per Jones criteria, but with the addition of recent scarlet fever.

• #18 Acute rheumatic fever diagnosis and management: Review of the global implications of the new revised diagnostic criteria with a focus on Saudi Arabia

  https://pmc.ncbi.nlm.nih.gov/articles/PMC6734099/

  To diagnose a patient with RF as a first episode of the disease, a confirmation of two major criteria or one major and two minor criteria is required, along with evidence of antecedent GAS infection. […] The evidence of GAS infection is confirmed by one of the following: a positive throat culture for GAS; increasing trend anti-streptolysin O titer (ASO) readings rather than a single titer result; or a positive rapid group A streptococcal carbohydrate antigen test in a child who clinically suggests a high pretest probability of streptococcal pharyngitis. […] The differences between low-risk and moderate- to high-risk populations in the major criteria are as follows. Arthritis must be polyarthritis in the low risk population, whereas in the moderate- to high-risk population it can be polyarthritis, polyarthralgia, and/or monoarthritis.

• #19 Rheumatic Fever – Pediatrics – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/pediatrics/miscellaneous-bacterial-infections-in-infants-and-children/rheumatic-fever

  ECG is done during the initial evaluation. […] Echocardiography can detect evidence of carditis even in patients without apparent murmurs and is recommended for all patients with confirmed or suspected ARF. […] ESR and serum CRP are sensitive but not specific. The ESR is typically 60 mm/hour. CRP is typically 3 mg/dL (30 mg/L) and often 7 mg/dL (70 mg/L); because it rises and falls faster than ESR, a normal CRP may confirm that inflammation is resolving in a patient with prolonged ESR elevation after acute symptoms have subsided. […] The differential diagnosis includes JIA (especially systemic JIA and, less so, polyarticular JIA), Lyme disease, reactive arthritis, arthropathy of sickle cell disease, leukemia or other cancer, systemic lupus erythematosus, embolic bacterial endocarditis, serum sickness, Kawasaki disease, drug reactions, and gonococcal arthritis.

• #20 Rheumatic fever, erythema marginatum

  https://dermnetnz.org/topics/rheumatic-fever

  Other tests used in the assessment of a patient with suspected ARF include: Blood tests markers of inflammation, such as ESR or CRP, may be raised […] Electrocardiogram and echocardiogram to identify heart involvement […] Doppler and colour flow mapping to detect minor valvular defects not evident clinically.

• #21 Rheumatic Fever: Causes, Symptoms, and Treatment | Doctor

  https://patient.info/doctor/rheumatic-fever-pro

  Rheumatic fever (RF) used to be a fairly common disease among children in developed countries until about the middle of the 20th century. […] The diagnosis is based on major and minor criteria. In the acute disease the arthritis and toxicity are obvious but it can be more insidious with mild carditis. This probably accounts for only about half of those with typical rheumatic heart disease giving a history of RF. […] Diagnosis is based on Jones Criteria that were devised in 1944, revised in 1992 and updated in 2015. The update included the role of echocardiography to detect subclinical valvular lesions. They can be used to identify patients with a high likelihood of having RF. […] Throat swabs are usually performed but may fail to grow streptococci by the time symptoms of RF appear. […] Clinical features begin when antibodies are at a peak. Antistreptococcal antibodies are especially useful in patients with only chorea. Sensitivity can be improved by testing for several antibodies. […] RF should still be considered as a likely diagnosis, even if criteria are not fully satisfied, when there is chorea or carditis without apparent cause and recent streptococcal infection, or when the patient has had previous RF and has symptoms of a recurrence.

• #22 What is Rheumatic Fever? What Causes This Strep Throat Complication?

  https://www.webmd.com/a-to-z-guides/understanding-rheumatic-fever-basics

  Rheumatic Fever Diagnosis […] To figure out if you have the streptococcus bacteria, your doctor will do a throat culture. This uncomfortable but safe procedure involves swabbing a sample of throat mucus. Your doctor will send it to the lab for analysis, which usually takes 24 hours. Some doctors use a rapid strep test that can give results in about 5 minutes, but it isn’t as accurate as the culture. […] Your doctor will also give you a complete exam, which includes listening to your heart for any signs of trouble, such as a heart „murmur” (indicating potential valve issues). They will also look for other telltale symptoms, such as arthritis in more than one joint and small nodules that often appear on the joints, especially the elbows. […] Other tests to diagnose rheumatic fever include: a blood test that checks for antibodies related to a recent group A strep infection, Electrocardiogram or EKG to find out how well your heart is working, Echocardiography or echo, which shows your heart muscle in action.

• #23 Clinical update – diagnosis of ARF | Rheumatic Heart Disease Australia

  https://www.rhdaustralia.org.au/news/clinical-update-diagnosis-arf

  Evidence of a recent Strep A infection completes the recipe for ARF diagnosis, and swabbing the throat is a relatively easy way to collect a sample. […] The serum ASO titre usually rises within one to two weeks after infection, and peaks at about three to six weeks, while the serum anti-DNase B titre can take up to six to eight weeks to peak. […] Strep A rapid tests include rapid antigen detection tests (RADT) and recently developed molecular tests for detecting Strep A DNA.

• #24 Rheumatic Fever – Pediatrics – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/pediatrics/miscellaneous-bacterial-infections-in-infants-and-children/rheumatic-fever

  ECG is done during the initial evaluation. […] Echocardiography can detect evidence of carditis even in patients without apparent murmurs and is recommended for all patients with confirmed or suspected ARF. […] ESR and serum CRP are sensitive but not specific. The ESR is typically 60 mm/hour. CRP is typically 3 mg/dL (30 mg/L) and often 7 mg/dL (70 mg/L); because it rises and falls faster than ESR, a normal CRP may confirm that inflammation is resolving in a patient with prolonged ESR elevation after acute symptoms have subsided. […] The differential diagnosis includes JIA (especially systemic JIA and, less so, polyarticular JIA), Lyme disease, reactive arthritis, arthropathy of sickle cell disease, leukemia or other cancer, systemic lupus erythematosus, embolic bacterial endocarditis, serum sickness, Kawasaki disease, drug reactions, and gonococcal arthritis.

• #25 Rheumatic Fever | Riley Children’s Health

  https://www.rileychildrens.org/health-info/rheumatic-fever

  Complete blood count (CBC). Your child’s doctor may order a CBC to make sure there is no other condition that could be mimicking the symptoms of rheumatic fever. […] Of the above symptoms, it is most important for the carditis to be treated as soon as possible to avoid damage to the heart and heart valves. Pediatric rheumatologists are experienced in diagnosing rheumatic fever so treatment can begin quickly.

• #26 Rheumatic fever – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/rheumatic-fever/diagnosis-treatment/drc-20354594

  There’s no single test for rheumatic fever. Diagnosis of rheumatic fever is based on medical history, a physical exam and certain test results. […] Tests for rheumatic fever include: […] Blood tests can be done to check for signs of inflammation in the body. These tests include C-reactive protein (CRP) and the erythrocyte sedimentation rate (ESR), also called the sed rate. […] Another blood test can be done to look for proteins related to the strep bacteria. These proteins are called antibodies. […] This test shows how the heart is beating. It can help diagnose irregular heartbeats. A healthcare professional can check ECG signal patterns for signs of heart swelling. […] Sound waves are used to create pictures of the heart in motion. An echocardiogram shows the structure of the heart and how blood flows through it. […] It’s important to have regular health checkups after having rheumatic fever. Heart damage from rheumatic fever might not show up for many years even decades. Always tell your healthcare provider about any history of rheumatic fever.

• #27 Acute rheumatic fever diagnosis and management: Review of the global implications of the new revised diagnostic criteria with a focus on Saudi Arabia

  https://pmc.ncbi.nlm.nih.gov/articles/PMC6734099/

  The revised criteria are summarized in Table 1. […] Most importantly, regardless of the risk stratification, the latest update recommends using echocardiography with Doppler to diagnose carditis and subclinical carditis in all patients. […] The concept of subclinical carditis, which is defined as positive findings of mitral or aortic valvitis on an echocardiogram without heart murmurs or other clinical signs, has emerged as a major criterion. […] The diagnostic criteria for an initial RF episode in low-risk patients have not changed from the Jones criteria published in 1992. […] However, in the update published in 2015, polyarthralgia and monoarthritis are considered as major criteria in patients belonging to the moderate- to high-risk group. […] The minor criteria stipulate an ESR 60mm in the 1st hour in low-risk individuals but an ESR 30mm/h in moderate- to high-risk patients.

• #28 Diagnosing Acute Rheumatic Fever | Group A Strep | CDC

  https://www.cdc.gov/group-a-strep/hcp/clinical-guidance/diagnosing-acute-rheumatic-fever.html

  There’s no definitive diagnostic test for acute rheumatic fever. […] A clinical diagnosis of acute rheumatic fever should be made using the 2015 revised Jones Criteria. […] Use the Jones criteria to make a clinical diagnosis of acute rheumatic fever. […] The presence of the following indicates a high probability of an initial acute rheumatic fever illness in any risk population: 2 major manifestations, 1 major and 2 minor manifestations. […] In some instances, a presumptive diagnosis of acute rheumatic fever can be made without fulfilling the Jones Criteria. […] A presumptive diagnosis of a recurrence can be made with any of the following: 2 major manifestations, 1 major and 2 minor manifestations, 3 minor manifestations. […] Routine echocardiography/Doppler is now recommended for all confirmed or suspected acute rheumatic fever cases.

• #29 Rheumatic fever | Better Health Channel

  https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/rheumatic-fever

  Rheumatic fever is a disease that can occur following an infection caused by the Group A streptococcus bacterium. […] There is no specific test available to diagnose rheumatic fever. The range of tests may include: […] Medical history, including evidence of a prior streptococcal infection […] Physical examination […] Throat swabs to test for the presence of Group A streptococcus bacteria […] Blood tests to look for markers that suggest inflammation is present […] Electrocardiogram (ECG) to monitor the electrical activity of the heart […] Chest x-rays to look at the heart for signs of enlargement and the lungs for congestion.

• #30 Acute rheumatic fever diagnosis and management: Review of the global implications of the new revised diagnostic criteria with a focus on Saudi Arabia

  https://pmc.ncbi.nlm.nih.gov/articles/PMC6734099/

  The revised criteria are summarized in Table 1. […] Most importantly, regardless of the risk stratification, the latest update recommends using echocardiography with Doppler to diagnose carditis and subclinical carditis in all patients. […] The concept of subclinical carditis, which is defined as positive findings of mitral or aortic valvitis on an echocardiogram without heart murmurs or other clinical signs, has emerged as a major criterion. […] The diagnostic criteria for an initial RF episode in low-risk patients have not changed from the Jones criteria published in 1992. […] However, in the update published in 2015, polyarthralgia and monoarthritis are considered as major criteria in patients belonging to the moderate- to high-risk group. […] The minor criteria stipulate an ESR 60mm in the 1st hour in low-risk individuals but an ESR 30mm/h in moderate- to high-risk patients.

• #31 Rheumatic fever Identification, management and secondary prevention

  https://www.racgp.org.au/afp/2012/january-february/rheumatic-fever

  Initially described in 1944 by Jones, the diagnostic criteria for ARF separate the clinical features into major and minor manifestations major manifestations being more specific for the disease. The Jones criteria were last revised in 1992 to increase their specificity for ARF because the incidence in developed nations had decreased significantly. In 2006, the National Heart Foundation of Australia (NHFA) and the Cardiac Society of Australia and New Zealand (CSANZ) developed diagnostic and treatment guidelines for use in Australia, allowing for increased sensitivity among identified high risk groups. […] High risk refers to groups with high rates of ARF, such as Aboriginal and Torres Strait Islander communities living in rural or remote areas or in disadvantaged suburban areas. Sydenham (rheumatic) chorea is present in roughly 25% of Aboriginal Australians (especially female adolescents) with ARF. As part of the major manifestations, Sydenham chorea is sufficient to diagnose ARF without evidence of previous S. pyogenes infection, provided other causes of chorea have been excluded. The NHFA criteria consider some less specific symptoms, such as polyarthralgia and aseptic monoarthritis, to be major manifestations in high risk groups.

• #32 Diagnosing Acute Rheumatic Fever | Group A Strep | CDC

  https://www.cdc.gov/group-a-strep/hcp/clinical-guidance/diagnosing-acute-rheumatic-fever.html

  There’s no definitive diagnostic test for acute rheumatic fever. […] A clinical diagnosis of acute rheumatic fever should be made using the 2015 revised Jones Criteria. […] Use the Jones criteria to make a clinical diagnosis of acute rheumatic fever. […] The presence of the following indicates a high probability of an initial acute rheumatic fever illness in any risk population: 2 major manifestations, 1 major and 2 minor manifestations. […] In some instances, a presumptive diagnosis of acute rheumatic fever can be made without fulfilling the Jones Criteria. […] A presumptive diagnosis of a recurrence can be made with any of the following: 2 major manifestations, 1 major and 2 minor manifestations, 3 minor manifestations. […] Routine echocardiography/Doppler is now recommended for all confirmed or suspected acute rheumatic fever cases.

• #33 Acute Rheumatic Fever | Johns Hopkins ABX Guide

  https://www.hopkinsguides.com/hopkins/view/Johns_Hopkins_ABX_Guide/540006/all/Acute_Rheumatic_Fever

  Revised Jones Criteria (2015, AHA): for all w/ evidence of preceding GAS infection. […] Evidence of GAS preceding infection: required either Increased or rising ASO or anti-DNASE B titers. A rising titer is considered more reliable than a single titer result. […] Positive throat culture for GAS. […] Positive rapid GAS antigen test in a child with consistent clinical presentation. […] Initial ARF: 2 Major OR 1 Major and 2 Minor […] Recurrent ARF: 2 Major OR 1 Major and 2 Minor OR 3 Minor. […] WHO Criteria (2004): less stringent than Jones criteria. Chorea and indolent carditis do not require evidence of antecedent group A streptococcus infection. […] First episode per Jones criteria […] Recurrent episodes: If no established RHD: as per the first episode […] If established RHD: requires two minor manifestations, plus evidence of antecedent group A streptococcus infection. Evidence of antecedent group A streptococcus infection as per Jones criteria, but with the addition of recent scarlet fever.

• #34 Rheumatic Fever – Pediatrics – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/pediatrics/miscellaneous-bacterial-infections-in-infants-and-children/rheumatic-fever

  ECG is done during the initial evaluation. […] Echocardiography can detect evidence of carditis even in patients without apparent murmurs and is recommended for all patients with confirmed or suspected ARF. […] ESR and serum CRP are sensitive but not specific. The ESR is typically 60 mm/hour. CRP is typically 3 mg/dL (30 mg/L) and often 7 mg/dL (70 mg/L); because it rises and falls faster than ESR, a normal CRP may confirm that inflammation is resolving in a patient with prolonged ESR elevation after acute symptoms have subsided. […] The differential diagnosis includes JIA (especially systemic JIA and, less so, polyarticular JIA), Lyme disease, reactive arthritis, arthropathy of sickle cell disease, leukemia or other cancer, systemic lupus erythematosus, embolic bacterial endocarditis, serum sickness, Kawasaki disease, drug reactions, and gonococcal arthritis.

• #35 Rheumatic Fever: Problems in Diagnosis | Consultant360

  https://www.consultant360.com/exclusives/rheumatic-fever-problems-diagnosis

  Rheumatic fever gets its name from febrile polyarthritis, its most common feature. However, many patients with rheumatic fever may not be febrile, may not have polyarthritis, or may not be rheumatic at all. This variability of symptoms has led to considerable confusion and erroneous beliefs about the causes and treatment of rheumatic fever. […] Fortunately, recent studies have clarified the disease process involved. They have improved the objectivity and accuracy of auscultation, and have shown that rheumatic fever invariably develops in association with Group A hemolytic streptococcal infections. Thus, rheumatic fever may be defined as a post-streptococcal inflammatory state characterized by arthritis, carditis, or chorea appearing singly or in combination. […] Arthritis, when it occurs, is easy to recognize; however, it should be verified by objective evidence of inflammation in the joints, and differentiated from arthralgia, myalgia, or bone pains. The presence of febrile arthritis should provoke a search for associated carditis. Keep in mind, however, that carditis is too often „found” where it does not exist. If carditis is absent in a patient with febrile arthritis, rheumatic fever remains a likely diagnosis unless sequential tests of several antibodies fail to show a streptococcal infection, or unless the arthritis does not respond to appropriate therapy; in that case, you need to rule out lupus erythematosus, rheumatoid arthritis, gout, sickle cell disease, or other alternative diagnoses.

• #36 Rheumatic fever: Causes, symptoms, and treatment

  https://www.medicalnewstoday.com/articles/176648

  RF can have long-term complications, the most common being rheumatic heart disease (RHD) which develops in 30 to 45 percent of those with RF. […] RF is caused by a reaction to the bacteria that cause strep throat, so that diagnosis and treatment of this condition can prevent it from developing into RF. […] The doctor will ask about the patients symptoms and recent medical history. They will pay particular attention to any recent illness along with the following: swelling, pain, and stiffness in the joints, any jerky, involuntary movements, a red or pink skin rash, small nodules or lumps and bumps under the skin, especially on the elbows, ankles, knees, and knuckles, irregular heart rhythm. […] Tests may include: Electrocardiogram (EKG): An electrical tracing of the heart to detect abnormal heart rhythms suggesting inflammation, Echocardiography: An ultrasound of the heart to look for inflammation or heart valve damage, Blood tests. […] Additional tests can detect specific strep infections.

• #37 Acute Rheumatic Fever: Practice Essentials, Pathophysiology, Etiology

  https://emedicine.medscape.com/article/236582-workup

  Diagnosis rests on a combination of clinical manifestations that can develop in relation to group A streptococcal pharyngitis. […] These include chorea, carditis, subcutaneous nodules, erythema marginatum, and migratory polyarthritis. […] The pathogenesis of ARF and rheumatic heart disease is complex and not fully understood. […] ARF often produces a pancarditis, characterized by endocarditis, myocarditis, and pericarditis. […] Carditis causes the most severe clinical manifestation because heart valves can be permanently damaged. […] The disorder also can involve the pericardium, myocardium, and the free borders of valve cusps. […] Chronic valvular disease may develop even in patients who initially recovered without signs of valvular damage. […] After a first attack of ARF, the course is highly variable and unpredictable.

• #38 Clinical update – diagnosis of ARF | Rheumatic Heart Disease Australia

  https://www.rhdaustralia.org.au/news/clinical-update-diagnosis-arf

  For everyone, a definite recurrent episode of ARF with a documented history of ARF or RHD now requires 2 major, or 1 major and 2 minor (not 1 minor), or 3 minor criteria, plus evidence of preceding Strep A infection. […] ARF can be difficult to diagnose. […] Medical and nursing staff working in areas with high rates of ARF should have a heightened level of suspicion and be familiar with recommended management of people suspected to have ARF. […] All people suspected to have ARF should be admitted to hospital within 24 hours where possible, for timely blood testing, echocardiography and specialist review, monitoring of fever and joint symptoms, and disease education. […] Echocardiogram is mandatory for all people with possible or confirmed ARF, even if the criteria for notification of ARF have been met.

• #39 Rheumatic Fever: Causes, Symptoms (Rash) & Treatment

  https://my.clevelandclinic.org/health/diseases/16616-rheumatic-fever

  Treating strep throat and scarlet fever early is essential. It can prevent rheumatic fever. Strep throat and scarlet fever symptoms arent always obvious or easy to spot. […] Rheumatic fever is a rare complication of untreated strep throat or scarlet fever. It most commonly affects children and teens.

• #40 Clinical Guidance for Acute Rheumatic Fever | Group A Strep | CDC

  https://www.cdc.gov/group-a-strep/hcp/clinical-guidance/acute-rheumatic-fever.html

  There’s no definitive diagnostic test for acute rheumatic fever. Instead, the Jones Criteria and supplemental testing are used. […] Diagnosis and adequate treatment of group A strep pharyngitis and skin infections are the primary means of preventing acute rheumatic fever.

• #41 Rheumatic fever Identification, management and secondary prevention

  https://www.racgp.org.au/afp/2012/january-february/rheumatic-fever

  Evidence of preceding GAS infection can be gathered from serum streptococcal antibody titres. However, standard laboratory reporting uses upper limits of normal from adult populations and therefore does not reflect the normal titres in children. […] General practitioners are integral to ensuring early diagnosis and early treatment of ARF to minimise heart valve damage and progression to RHD. Clinical features raising a high suspicion of ARF are shown in Table 3. Work-up and management of suspected ARF is shown in Table 4. Following diagnosis of ARF, appropriate patient education and administration of secondary prophylaxis with benzathine penicillin G can prevent or decrease recurrences of ARF. […] Following confirmation of ARF diagnosis, intramuscular (IM) benzathine penicillin G injections must be given every 3-4 weeks for a minimum of 10 years as secondary prophylaxis. This places a considerable burden on families and patients and is particularly challenging if the family does not have easy access to medical care. Adherence to the regimen is a major consideration, particularly if the patient finds the injections painful or believes them unnecessary. Patient education regarding the recurrent nature of ARF and the serious potential long term consequences of the disease is essential.

• #42 Acute Rheumatic Fever – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK594238/

  A presumptive diagnosis of ARF may be made without using the Jones Criteria in patients presenting with Sydenham chorea or indolent carditis months after GAS infection. […] The number of laboratory tests available to diagnose GAS infection has vastly increased. […] The available modalities used to diagnose GAS infection include throat culture, rapid antigen detection tests (RADT), nucleic acid amplification tests, and antistreptolysin O (ASO) or antideoxyribonuclease B (ADB) antibody titers. […] All patients with ARF should undergo cardiac evaluation with chest radiography, electrocardiography (ECG), and echocardiography. […] The treatment of ARF is multimodal and involves GAS eradication therapy, symptomatic treatment, and prophylaxis to prevent recurrence. […] The recommended antibiotic for GAS eradication therapy is penicillin; dosage is based on the patient’s weight. […] Patients with a history of ARF are at increased risk for disease recurrence and worsening RHD and should receive secondary antibiotic prophylaxis against GAS infections.

• #43 Acute Rheumatic Fever: Practice Essentials, Pathophysiology, Etiology

  https://emedicine.medscape.com/article/236582-workup

  The outcome of carditis is likely to be more severe in patients with pre-existing heart disease. […] Joint inflammation can take up to a month to resolve without treatment but almost never causes lasting damage. […] In an Australian study, recurrence of ARF occurred most often in the first year after initial ARF episode (incidence 3.7 per 100 person-years), but low-level risk persisted for more than 10 years. […] Risk of progression to rheumatic heart disease was also highest in the first year (incidence 35.9%), almost 10 times higher than that of ARF recurrence.

• #44

  https://www.who.int/publications/i/item/9789240100077

  Rheumatic fever (RF) and Rheumatic heart disease (RHD) are a preventable public health problem in low- and middle-income countries and in marginalized communities in middle- and high-income countries. […] The WHO guideline on the prevention and diagnosis of rheumatic fever (RF) and rheumatic heart disease (RHD) provides evidence-informed recommendations for the prevention and management of RF and RHD. […] It encompasses three areas; 1) primary prevention of rheumatic fever and rheumatic heart disease, specifically the identification and treatment of suspected group A (beta-haemolytic) Streptococcus (GAS) pharyngitis and skin infections; 2) secondary prevention of recurrent rheumatic fever and of rheumatic heart disease, specifically use of long-term antibiotic prophylaxis, interventions to increase adherence to antibiotic prophylaxis, and screening for early rheumatic heart disease; and 3) management of rheumatic fever, specifically the treatment with anti-inflammatory drugs.

• #45 Rheumatic Fever | Causes, Symptoms and Treatment

  https://patient.info/infections/rheumatic-fever-leaflet

  Rheumatic fever is an inflammatory disease and is caused by your immune system overreacting to the beta-haemolytic streptococcus bacteria. […] The diagnosis is usually made by the history of a sore throat (or a bad skin infection) followed, a few weeks later, by the typical features and symptoms. A blood test to show a recent infection with the streptococcus bacterium (called an antistreptolysin titre) can help to confirm that the bacterium has been in your body. […] But then there is a scoring system using major criteria and minor criteria. You need two majors, or one major and two minors, to make the diagnosis. […] To see the problems on the heart, a specialist will usually use an echocardiogram: a special scan to see the inside of the heart. But in many parts of the developing world there are not echocardiograms available.

• #46

  https://www.who.int/publications/i/item/9789240100077

  Rheumatic fever (RF) and Rheumatic heart disease (RHD) are a preventable public health problem in low- and middle-income countries and in marginalized communities in middle- and high-income countries. […] The WHO guideline on the prevention and diagnosis of rheumatic fever (RF) and rheumatic heart disease (RHD) provides evidence-informed recommendations for the prevention and management of RF and RHD. […] It encompasses three areas; 1) primary prevention of rheumatic fever and rheumatic heart disease, specifically the identification and treatment of suspected group A (beta-haemolytic) Streptococcus (GAS) pharyngitis and skin infections; 2) secondary prevention of recurrent rheumatic fever and of rheumatic heart disease, specifically use of long-term antibiotic prophylaxis, interventions to increase adherence to antibiotic prophylaxis, and screening for early rheumatic heart disease; and 3) management of rheumatic fever, specifically the treatment with anti-inflammatory drugs.

• #47 AHA Guidelines on Prevention of Rheumatic Fever and Diagnosis and Treatment of Acute Streptococcal Pharyngitis | AAFP

  https://www.aafp.org/pubs/afp/issues/2010/0201/p346.html

  Continuous prophylaxis is recommended in patients with well-documented histories of rheumatic fever and in those with evidence of rheumatic heart disease. Prophylaxis should be initiated as soon as acute rheumatic fever or rheumatic heart disease is diagnosed. To eradicate residual GAS, a full course of penicillin should be given to patients with acute rheumatic fever, even if a throat culture is negative. […] Continuous antimicrobial prophylaxis provides the most effective protection from recurrences of rheumatic fever. Because the risk of recurrence depends on many factors, physicians should determine the appropriate duration of prophylaxis on a case-by-case basis while also considering the presence of rheumatic heart disease.

• #48 Acute Rheumatic Fever – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK594238/

  A presumptive diagnosis of ARF may be made without using the Jones Criteria in patients presenting with Sydenham chorea or indolent carditis months after GAS infection. […] The number of laboratory tests available to diagnose GAS infection has vastly increased. […] The available modalities used to diagnose GAS infection include throat culture, rapid antigen detection tests (RADT), nucleic acid amplification tests, and antistreptolysin O (ASO) or antideoxyribonuclease B (ADB) antibody titers. […] All patients with ARF should undergo cardiac evaluation with chest radiography, electrocardiography (ECG), and echocardiography. […] The treatment of ARF is multimodal and involves GAS eradication therapy, symptomatic treatment, and prophylaxis to prevent recurrence. […] The recommended antibiotic for GAS eradication therapy is penicillin; dosage is based on the patient’s weight. […] Patients with a history of ARF are at increased risk for disease recurrence and worsening RHD and should receive secondary antibiotic prophylaxis against GAS infections.

• #49 Rheumatic fever – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/rheumatic-fever/diagnosis-treatment/drc-20354594

  There’s no single test for rheumatic fever. Diagnosis of rheumatic fever is based on medical history, a physical exam and certain test results. […] Tests for rheumatic fever include: […] Blood tests can be done to check for signs of inflammation in the body. These tests include C-reactive protein (CRP) and the erythrocyte sedimentation rate (ESR), also called the sed rate. […] Another blood test can be done to look for proteins related to the strep bacteria. These proteins are called antibodies. […] This test shows how the heart is beating. It can help diagnose irregular heartbeats. A healthcare professional can check ECG signal patterns for signs of heart swelling. […] Sound waves are used to create pictures of the heart in motion. An echocardiogram shows the structure of the heart and how blood flows through it. […] It’s important to have regular health checkups after having rheumatic fever. Heart damage from rheumatic fever might not show up for many years even decades. Always tell your healthcare provider about any history of rheumatic fever.

• #50 Rheumatic Fever (in Children & Babies) – Symptoms & Treatment | Carle.org

  https://carle.org/conditions/pediatric-conditions/rheumatic-heart-disease

  How Is Rheumatic Fever Diagnosed? The health care provider will suspect a diagnosis from the medical history, physical examination, and laboratory tests. A chest x-ray, electrocardiography (ECG), and throat culture will be done. The health care provider will order another test called echocardiography to look for heart valve damage. […] If heart damage is present, you will be referred to a cardiologist (a doctor who specializes in heart diseases).

• #51 Acute Rheumatic Fever : Emergency Care BC

  https://emergencycarebc.ca/clinical_resource/clinical-summary/acute-rheumatic-fever-2/

  GAS throat culture or positive rapid GAS antigen test in the case of high pre-test probability for GAS pharyngitis (Class 1, Level B) […] Most patients with acute rheumatic fever are admitted to hospital to facilitate diagnostic work-up, initiate treatment, and provide education to the patient and the family. […] Patients with acute rheumatic fever, and especially those with carditis require referral to cardiology for ongoing management and serial echocardiography.

• #52

  https://journals.lww.com/jaapa/fulltext/2022/05000/diagnosis,_management,_and_prevention_of_acute.2.aspx

  The primary treatment for arthritis related to acute rheumatic fever is high-dose aspirin. Aspirin has been better researched, but naproxen is an alternative because it can be taken just twice daily and has a reduced adverse reaction profile. […] The reduction of the overall incidence of acute rheumatic fever and rheumatic heart disease in the United States is directly the result of prevention. Prevention of acute rheumatic fever is categorized as primordial, primary, and secondary.

• #53 Rheumatic Fever (ARF)

  https://www.utmb.edu/pedi_ed/CoreV2/Cardiology/cardiologyV2/cardiologyV220.html

  Rheumatic Fever (ARF) is an inflammation of the heart, skin, joints and/or brain which develops after infection with Group A streptococci, such as „strep” throat, or scarlet fever. […] There is a 2-3 weeks delay between the strep infection and the development of ARF. Less than 3% of those with untreated strep infection may develop ARF. Most of the affected patients are between six and fifteen years of age. […] According to Jones Criteria, there must be evidence of previous streptococcal infection. […] For ARF diagnosis, 2 major OR one major + two minor criteria are needed. […] Treatment of the group A streptococcal infection. […] Bed rest is essential in patients with cardiac involvement. Carditis resulting in heart failure is treated with conventional measures. Diuretics are the mainstay of therapy. Close monitoring is needed for development of arrhythmias in patients with active myocarditis. […] Patients with a documented history of ARF should receive antibiotic prophylaxis until the age of 21 or for a minimum of five years if there is no cardiac involvement. Patients with valvular abnormalities should receive lifetime prophylaxis.

• #54 Rheumatic Fever (ARF)

  https://www.utmb.edu/pedi_ed/CoreV2/Cardiology/cardiologyV2/cardiologyV220.html

  Rheumatic Fever (ARF) is an inflammation of the heart, skin, joints and/or brain which develops after infection with Group A streptococci, such as „strep” throat, or scarlet fever. […] There is a 2-3 weeks delay between the strep infection and the development of ARF. Less than 3% of those with untreated strep infection may develop ARF. Most of the affected patients are between six and fifteen years of age. […] According to Jones Criteria, there must be evidence of previous streptococcal infection. […] For ARF diagnosis, 2 major OR one major + two minor criteria are needed. […] Treatment of the group A streptococcal infection. […] Bed rest is essential in patients with cardiac involvement. Carditis resulting in heart failure is treated with conventional measures. Diuretics are the mainstay of therapy. Close monitoring is needed for development of arrhythmias in patients with active myocarditis. […] Patients with a documented history of ARF should receive antibiotic prophylaxis until the age of 21 or for a minimum of five years if there is no cardiac involvement. Patients with valvular abnormalities should receive lifetime prophylaxis.

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