CLINICAL DESCRIPTION

A nonsuppurative acute inflammatory complication of Group A streptococcal infections, characterized mainly by arthritis, chorea, or carditis appearing alone or in combination, with residual heart disease as a possible sequel of the carditis.
Major criteria: a) carditis, b) polyarthritis; c) chorea; d) subcutaneous nodules; and e) erythema marginatum.
Minor criteria: a) previous rheumatic fever or rheumatic heart disease; b) arthralgia; c) fever; d) elevated erythrocyte sedimentation rate, positive C-reactive protein, or leukocytosis; and e) prolonged PR interval on an electrocardiogram.
Supporting evidence of preceding streptococcal infection: a) increased antistreptolysin-O or other streptococcal antibodies; or b) throat culture positive for group A streptococcus; or c) recent scarlet fever. The rheumatic fever can occur 1 to 5 weeks (mean = 19 days) after streptococcal infection.

  CASE CLASSIFICATION

1. CONFIRMED

   An illness presenting WITH:

   • two major criteria, OR
   • one major and two minor criteria, AND
   • supporting evidence of preceding Group A Streptococcus infection.
   
   
2. PROBABLE
   

   • Not used

3. POSSIBLE
   
   

   • Initially reported on the basis of clinical diagnosis, until confirmation is obtained; no possible case classifications are retained.

NOTE: The absence of supporting evidence of preceding streptococcal infection should make the diagnosis doubtful, except in Sydenham chorea or low-grade carditis when rheumatic fever is first discovered after a long latent period from the antecedent infection.