Rheumatic Fever

Major criteria

§         Polyarthritis: A temporary migrating inflammation of the large joints, usually starting in the legs and migrating upwards.

§         Carditis: Inflammation of the heart muscle which can manifest as congestive heart failure with shortness of breath, pericarditis with a rub, or a new heart murmur.

§         Subcutaneous nodules: Painless, firm collections of collagen fibers over bones or tendons. They commonly appear on the back of the wrist, the outside elbow, and the front of the knees.

§         Erythema marginatum: A long lasting rash that begins on the trunk or arms as macules and spreads outward to form a snake like ring while clearing in the middle. This rash never starts on the face and it is made worse with heat.

§         Sydenham’s chorea (St. Vitus’ dance): A characteristic series of rapid movements without purpose of the face and arms. This can occur very late in the disease for at least three months from onset of infection.

Minor criteria

§         Fever of 38.2–38.9 °C (101–102 °F)

§         Neuralgia: Joint pain without swelling (Cannot be included if polyarthritis is present as a major symptom)

§         Raised erythrocyte sedimentation rate or C reactive protein

§         Leukocytosis

§         ECG showing features of heart block, such as a prolonged PR interval (Cannot be included if carditis is present as a major symptom)

§         First Degree AV-Block 

§         Previous episode of rheumatic fever or inactive heart disease