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Rheumatic Fever

Anum Abbas, MD and Renuga Vivekanandan, MD Reviewed 06/2018
 


BASICS

DESCRIPTION

  • Acute rheumatic fever (ARF) is a delayed inflammatory sequela of group A Streptococcus (GAS) tonsillopharyngitis that affects multiple organ systems.

  • Can lead to rheumatic heart disea...

DIAGNOSIS

  • Requires laboratory evidence of preceding GAS infection (See “Initial Tests [lab, imaging].”)

  • Revised 2015 Jones criteria

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

  • Recurrent ARF: 2 major OR 1 m...

TREATMENT

GENERAL MEASURES

  • Antibiotic

  • Anti-inflammatory agent (aspirin or naproxen)

  • Manage cardiac manifestations as needed in addition to standard ARF treatment (e.g., dysrhythmia, pericarditis, myocard...

ONGOING CARE

FOLLOW UP RECOMMENDATIONS

  • ARF patients should be on a prophylactic antibiotic throughout childhood until age 21 years and possibly indefinitely depending on cardiac damage because recurren...

REFERENCES

1
Del Mar CB, Glasziou PP, Spinks AB. Antibiotics for sore throat. Cochrane Database Syst Rev.  2006;(4):CD000023. [View Abstract on OvidMedline]
2
Gewitz MH, Baltimore RS, Tani LY, et a...

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 inflammatory disease that affects multiple organ systems including the heart.

  • Modified Jones criteria for diagnosis include two major or one major plus two minor manifestation...

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