The Clinical Aspects of Rheumatic Fever in Adults

Rosenberg, David H.

doi:10.1056/nejm194601312340503

Cited by 12 publications

(6 citation statements)

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“…However, such variability in typical Jones criteria in both adult ARF and high-risk populations had previously been described. For over 70 years, ARF was well known to present atypically in adults based on several published studies of >1500 people including military personnel 4 8 9 23. However, and importantly for an atypical ARF presentation, arthralgia, carditis, elevated ESR and low-grade persistent fever were the most common symptoms 4 8 9 19 23–26.…”

Section: Discussionmentioning

confidence: 99%

“…For over 70 years, ARF was well known to present atypically in adults based on several published studies of >1500 people including military personnel 4 8 9 23. However, and importantly for an atypical ARF presentation, arthralgia, carditis, elevated ESR and low-grade persistent fever were the most common symptoms 4 8 9 19 23–26. It has been suggested that arthralgia and low-grade fever may represent a milder form of rheumatic fever8 ; and it was further suggested to make exceptions for such presentation of minor Jones criteria, especially when rheumatic fever is endemic in the population 3.…”

Section: Discussionmentioning

confidence: 99%

“…Using the 2015 modified Jones criteria for high-risk populations, our specific case initially met only minor Jones criteria (fever, joint pain (monoarthralgia) in the neck and elevated acute phase reactants/ESR). Interestingly, this case displayed two of the most common features of ARF (arthralgia and fever) early on in its course 2 8. However, diagnosis of ARF using minor criteria is not recommended and is of limited diagnostic value since these features occur in other diseases 2 10.…”

Section: Introductionmentioning

confidence: 94%

“…ARF can also have presentations that do not follow the classical Jones criteria. Atypical ARF was documented over 70 years ago in published reports for ~1500 adult cases (eg, n=1000,8 367,4 243) 9. It was speculated that the milder form of rheumatic fever which presents with arthralgia and low-grade fever results in increased misdiagnoses 8.…”

Section: Introductionmentioning

confidence: 99%

“…Atypical ARF was documented over 70 years ago in published reports for ~1500 adult cases (eg, n=1000,8 367,4 243) 9. It was speculated that the milder form of rheumatic fever which presents with arthralgia and low-grade fever results in increased misdiagnoses 8. However, this disease is now rare in developed countries and atypical presentation in adults is no longer as well recognised.…”

Section: Introductionmentioning

confidence: 99%

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Atypical presentation of acute rheumatic fever (ARF) in a 25-year-old woman in the Caribbean: a challenging diagnosis

2020

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A 25-year-old woman presented a challenging diagnosis of acute rheumatic fever (ARF). Initial symptoms included dry cough and three minor Jones criteria (unabating fever (38.4°C, 0d), elevated acute phase reactants (C-reactive protein, 13d) and joint pain (monoarthralgia) in her neck (0d)). ARF was diagnosed only after presentation of two major Jones criteria (polyarthritis/polyarthralgia (16d) and erythema marginatum (41d)) and positive antistreptolysin O titre (44d). Parotid swelling, peripheral oedema, elevated liver enzymes and diffuse lymphadenopathy complicated the diagnosis. Throat swab, chorea and carditis were negative or absent. Atypical ARF is challenging to recognise. There is no diagnostic test and its presentation is similar to that of other diseases. While the 2015 Jones criteria modification increased specificity of ARF diagnosis, atypical cases may still be missed, especially by physicians in developed countries. Suspicion of atypical ARF, especially after travel to high incidence regions, would allow for earlier treatment and prevention of rheumatic heart disease.

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Section: Discussionmentioning

confidence: 99%