Sections View Full Chapter Figures Tables Videos Annotate Full Chapter Figures Tables Videos Supplementary Content +++ Key Features +++ Essentials of Diagnosis ++ Except in cases of rheumatic fever manifesting solely as Sydenham chorea or long-standing carditis, there should be clear evidence of a streptococcal infection such as Scarlet fever Positive throat culture for group A β-hemolytic streptococcus Increased antistreptolysin O or other streptococcal antibody titers The antistreptolysin O titer is significantly higher in rheumatic fever than in uncomplicated streptococcal infections +++ General Considerations ++ Overall incidence in the United States is < 1 per 100,000 Peak age of risk in the United States is 5–15 years Disease is slightly more common in girls and in African Americans +++ Clinical Findings ++ Carditis Implies pancardiac inflammation, but it may be limited to valves, myocardium, or pericardium Valvulitis is frequently seen, with the mitral valve most commonly affected Mitral insufficiency is the most common valvular residua An early decrescendo diastolic murmur consistent with aortic insufficiency is occasionally encountered as the sole valvular manifestation Most serious consequence of rheumatic fever Varies from minimal to life-threatening heart failure (HF) Polyarthritis The large joints (knees, hips, wrists, elbows, and shoulders) are most commonly involved Arthritis is typically migratory Joint swelling and associated limitation of movement should be present Occurs in 80% of patients Sydenham chorea Characterized by involuntary and purposeless movements Often associated with emotional lability Symptoms become progressively worse and may be accompanied by ataxia and slurring of speech Muscular weakness becomes apparent following the onset of the involuntary movements Chorea is self-limiting, although it may last up to 3 months Chorea may not be apparent for months to years after the acute episode of rheumatic fever Erythema marginatum A macular, serpiginous, erythematous rash with a sharply demarcated border appears primarily on the trunk and the extremities Face is usually spared Subcutaneous nodules Usually occur only in severe cases, and then most commonly over the joints, scalp, and spinal column Nodules vary from a few millimeters to 2 cm in diameter and are nontender and freely movable under the skin +++ Diagnosis +++ Jones criteria (modified) ++ Major manifestations Carditis Polyarthritis Sydenham chorea Erythema marginatum Subcutaneous nodules Minor manifestations: Clinical Previous rheumatic fever or rheumatic heart disease Polyarthralgia Fever Minor manifestations: Laboratory Acute phase reaction: elevated erythrocyte sedimentation rate, C-reactive protein, leukocytosis Prolonged PR interval plus Supporting evidence of preceding streptococcal infection, ie, increased titers of antistreptolysin O or other streptococcal antibodies, positive throat culture for group A streptococcus +++ Treatment ++ Long-acting benzathine penicillin Drug of choice Depending on the age and weight of the patient, a single intramuscular injection of 0.6–1.2 million units is effective Alternative penicillin regimens include Penicillin V, 250–500 mg orally 2–3 times a day for 10 days or Amoxicillin, 50 mg/kg (maximum 1 g) once daily for 10 days For patients allergic to penicillin,... Your MyAccess profile is currently affiliated with '[InstitutionA]' and is in the process of switching affiliations to '[InstitutionB]'. Please click ‘Continue’ to continue the affiliation switch, otherwise click ‘Cancel’ to cancel signing in. Get Free Access Through Your Institution Learn how to see if your library subscribes to McGraw Hill Medical products. Subscribe: Institutional or Individual Sign In Username Error: Please enter User Name Password Error: Please enter Password Forgot Username? Forgot Password? Sign in via OpenAthens Sign in via Shibboleth