Rheumatic Fever

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Acute Rheumatic Fever can present with several different clinical findings within weeks of a group A streptococcal (GAS) tonsillopharyngitis (or streptococcal pyoderma in patients from tropical regions). The possible major and minor manifestations are reviewed here. The criteria for diagnosis according to the modified Jones criteria are reviewed below;
The five MAJOR manifestations (and percent of patients with each) are:
1) Arthritis (usually migratory polyarthritis predominantly involving the large joints) – 50 to 70 percent
2) Carditis and valvulitis (eg, pancarditis) that is clinical or subclinical – 35 to 66 percent
3) Central nervous system involvement (eg, Sydenham chorea) – 10 to 30 percent
4) Subcutaneous nodules – 0 to 10 percent
5) Erythema marginatum – less than 6%
The four MINOR manifestations are:
1) Arthralgia
2) Fever
3) Elevated acute phase reactants (erythrocyte sedimentation rate [ESR], C-reactive protein [CRP])
4) Prolonged PR interval on electrocardiogram

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