PEDIATRICS
SYMPTOMS/EXAM
Variable, depending upon which organ systems are affected
■ Carditis causing damage to mitral or aortic valves, resulting in valvular
insufficiency
■ Mitral regurgitation murmur: Holosystolic at apex
■ Aortic regurgitation murmur: Diastolic at base
■ Arthritis, typically affecting >5 joints
■ Sydenham’s chorea due to CNS involvement
■ Erythema marginatum (serpiginous, evanescent rash that typically spares
the face)
■ Subcutaneous nodules (pea-sized bumps on the extensor surfaces of
extremities)
DIFFERENTIAL
■ JRA
■ Septic arthritis
■ Kawasaki syndrome
■ Myocarditis/pericarditis
■ SLE
■ Serum sickness
■ Henoch-Schönlein purpura
DIAGNOSIS
The JONES criteria (see Table 5.9) are used to confirm the diagnosis.
■ Routine labs should include CBC, ESR, antistreptolysin titers (ASO),
ECG, CXR, cardiac ECHO.
TABLE 5.9. 1992 JONES Criteria
- Evidence of preceding group A streptococcus infection:
■Elevated or rising ASO titer, or
■+Throat culture, or
■+Rapid antigen test
AND- Either two major manifestations, or one major and two minor manifestations:
Major manifestations:
■Carditis
■Polyarthritis
■Sydenham’s chorea
■Erythema marginatum
■Subcutaneous nodules
Minor manifestations:
■Arthralgia
■Fever
■Elevated ESR or CRP
■Prolonged PR interval on ECG
JONES criteria for
diagnosis of
rheumatic Fever—
Joints
Oh, no—carditis!
Nodules
Erythema marginatum
Sydenham’s chorea