Acute rheumatic fever without early carditis: an atypical clinical presentation

Abstract

a high index of suspicion and an awareness of the absence of early carditis are necessary to make the diagnosis of acute rheumatic fever.

Review of 609 patients with rheumatic fever in terms of revised and updated Jones criteria

“…The presence of arthralgia in almost 80% of our patients also supports the latest discussions on the increased frequency of polyarthralgia cases compared to arthritis some of which cannot be diagnosed as RF due to the absence of another major sign [16,18]. In addition, one-third of our cases with arthritis had monoarticular involvement.…”

“…A recent study from Northern Australia which reports a similar rate of monoarthritis discusses the importance of these cases which cannot be considered as RF since they do not fulfill the criteria [10]. An important percentage of these patients were later confirmed to have RF due to later development of carditis and such patients are also described in some other recent studies [16]. Since the main change in the 1992, Jones criteria is applicable only for the diagnosis of initial cases of RF (recognizing that recurrent cases may or may not fulfill the criteria), we focused on the initial RF attacks with monoarthritis without any accompanying major manifestation.…”

“…Latest discussions on minor findings involve the severity of fever, polyarthralgia or monoarthritis together with 2 other minor findings which can not be diagnosed as RF and some of which are now called poststreptococcic reactive arthritis (PSRA) [5,16]. American Heart Association expressed fever as ''usually at least 39 -C''; however this has not been made a strict rule [17].…”

Evaluation of the policy of secondary prevention against rheumatic fever among Egyptian children

“…15 Khriesat and Najada, found four cases (25%) with silent carditis which were established after echocardiography. 16 This finding shows it is important to repeat echocardiography over the period of next 3e4 weeks because the valvular involvement which was absent in the beginning may appear later. This validates that echocardiography results are the major criterion for diagnosis of ARF.…”

Unilateral pulmonary edema and acute rheumatic fever

“…Arthritis is frequently the only presenting symptom. Indolent carditis presenting without other supportive criteria is a common late presentation of this disease [4]. These factors may lead to delays in diagnosis and management.…”