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Acute rheumatic fever: Clinical manifestations and diagnosis

Author
Allan Gibofsky, MD, JD, FACP, FCLM
Section Editors
Robert Sundel, MD
Daniel J Sexton, MD
Deputy Editor
Elizabeth TePas, MD, MS

INTRODUCTION

Acute rheumatic fever (ARF) is a nonsuppurative sequela that occurs two to four weeks following group A Streptococcus 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 epidemiology, pathogenesis, treatment, and prevention of this disorder are presented separately. (See "Acute rheumatic fever: Epidemiology and pathogenesis" and "Acute rheumatic fever: Treatment and prevention".)

CLINICAL MANIFESTATIONS

Acute illness — ARF can present with several different clinical findings within weeks of a group A streptococcal (GAS) tonsillopharyngitis (or streptococcal pyoderma in patients from tropical regions) [1-3]. The possible major and minor manifestations are reviewed here (table 1). The criteria for diagnosis according to the modified Jones criteria [4] are reviewed below. (See 'Diagnosis' below.)

The five major manifestations (and percent of patients with each) are [4]:

Carditis and valvulitis (eg, pancarditis) that is clinical or subclinical – 50 to 70 percent

                    

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Literature review current through: Nov 2016. | This topic last updated: Wed Dec 09 00:00:00 GMT 2015.
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