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Rheumatic Fever

Stuart H. Batten, MD, Hillary J Darrow, Medical Degree and Reggie Q Taylor, DO Reviewed 06/2022
 


BASICS

DESCRIPTION

  • Acute rheumatic fever (ARF) is an autoimmune, inflammatory response to infection with group A Streptococcus (GAS) that affects multiple organ systems.

  • Untreated acute disease can lead...

DIAGNOSIS

  • 2015 Revised Jones Criteria and lab evidence of preceeding GAS infection are used for diagnosis.

  • Initial ARF: 2 major OR 1 major + 2 minor

  • Recurrent ARF: 2 major OR 1 major + 2 minor OR 3 mino...

TREATMENT

GENERAL MEASURES

  • Antibiotic

  • Anti-inflammatory agent (aspirin or naproxen)

  • Manage other manifestations as indicated (e.g., chorea, dysrhythmia, carditis, or heart failure).

MEDICATION

First Line

  • Er...

ONGOING CARE

FOLLOW-UP RECOMMENDATIONS

  • Secondary prophylaxis: antibiotic therapy from time of diagnosis until at least age 21 years, or 5 years after diagnosis (whichever comes later)

  • Indefinite prophyl...

REFERENCES

1
Lahiri S, Sanyahumbi, A. Acute rheumatic fever. Pediatrics in Review. 2021;42(5): 221-232.
2
Kumar RK, Antunes MJ, Beaton, A, et al; Contemporary diagnosis and management of rheumatic heart ...

ADDITIONAL READING

Ralph AP, Noonan S, Wade V, et al. The 2020 Australian guideline for prevention, diagnosis, and management of acute rheumatic fever and rheumatic heart disease. ...

CODES

ICD10

  • I00 Rheumatic fever without heart involvement

  • I01.9 Acute rheumatic heart disease, unspecified

  • I01.0 Acute rheumatic pericarditis

  • I01.1 Acute rheumatic endocarditis

  • I02.9 Rheumatic chorea witho...

CLINICAL PEARLS

  • ARF is an autoimmune, inflammatory disease that follows GAS pharyngitis or impetigo and affects multiple organ systems, including the heart.

  • Modified Jones criteria delineate between lo...

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