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Rheumatic Fever

Stuart H. Batten, MD and Edwin Y. Choi, MD Reviewed 06/2019
 


BASICS

DESCRIPTION

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

  • Can lead to rheumatic...

DIAGNOSIS

  • Mainly a clinical diagnosis

  • Laboratory evidence of preceding GAS infection is needed whenever possible (see “Initial Tests (lab, imaging)”)

  • Revised 2015 Jones criteria (4)[C]

  • Initial ARF: 2 maj...

TREATMENT

GENERAL MEASURES

  • Antibiotic

  • Anti-inflammatory agent (aspirin or naproxen)

  • Manage other manifestations as needed (e.g., chorea, dysrhythmia, pericarditis, myocarditis, valvular disease, or heart...

ONGOING CARE

FOLLOW-UP RECOMMENDATIONS

  • Secondary prophylaxis: ARF patients should be on a prophylactic antibiotic from time of diagnosis until at least age 21 years, and possibly indefinitely depending...

REFERENCES

1
Karthikeyan G, Guilherme L. Acute rheumatic fever. Lancet.  2018;392(10142):161–174. [View Abstract on OvidMedline]
2
Webb RH, Grant C, Harnden A. Acute rheumatic fever. BMJ.  2015...

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 a GAS pharyngeal infection and affects multiple organ systems, most notably, the heart.

  • Modified Jones criteria now delineate bet...

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