Latency After Streptococcus Pyogenes Infection: usually 2-3 weeks
Physiology
Antibody Cross-Reactivity Against Antigens Present in Heart, Joints, Skin, and Brain: xxx
Diagnosis
Antistreptolysin O (ASO): xxx
Streptococcal Antibody Titer: xxx
Throat Culture: xxx
Clinical-Jones Diagnostic Criteria
General Comments
Required for Diagnosis
Presence of 2 Major Criteria
Presence of 1 Major Criterion + 2 Minor Criteria
Potential Pitfalls with Strict Adherence to Jones Criteria: in areas of high rheumatic fever prevalence (for example, in Australian aboriginals), these criteria may result in underdiagnosis of rheumatic fever cases (where monoarthritis and low-grade fever were noted to be important clinical manifestations)
Alternative Clinical Scenarios Where Diagnosis Can Be Made Without Strict Adherence to Jones Criteria
Chorea as the Only Manifestation
Indolent Carditis as the Only Manifestation in Patient Evaluated Months After Streptococcus Pyogenes Infection
Recurrent Rheumatic Fever in Patient with a History of Prior Rheumatic Fever or Rheumatic Heart Disease: in these cases, caution should be exercised in diagnosing recurrent rheumatic fever in the presence of a single criterion (such as monoarthritis, fever, arthralgias, etc)
Major Criteria
Migratory Arthritis (see Arthritis, [[Arthritis]]): predominantly involving the large joints (typically starting in lower extremities and migrating upward)
Treatment with non-steroidal anti-inflammatory drugs (NSAID’s) may instead result in monoarthritis, rather than polyarthritis
Treatment with NSAID’s or corticosteroids before the presentation of rheumatic fever becomes recognizable may mask the clinical diagnosis: additionally, there is no evidence that withholding such treatment has any adverse impact on disease outcome
For these reasons, NSAID’s or corticosteroids should be used cautiously if rheumatic fever is suspected
Sydenham Chorea (“St. Vitus’ Dance”): rapid movements of face and arms
May occur late in the course, months after the initial infection
Erythema Marginatum: long-lasting rash that begins as macules on trunk/arms -> clear in the middle to form rings -> coalesce into snake-like appearance
Typically spares the face
Typically exacerbated by heat
Subcutaneous Nodules (see Papular-Nodular Skin Lesions, [[Papular-Nodular Skin Lesions]]): painless, firm, and typically located over bones or tendons (back of wrist, elbows, knees)
