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Rheumatic Fever
1997 Case Definition

Clinical Description

An inflammatory illness that occurs as a delayed sequela of group A streptococcal infection

Major criteria: carditis, polyarthritis, chorea, subcutaneous nodules, and 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

Laboratory Criteria for Diagnosis

No specific laboratory test exists for the diagnosis of rheumatic fever

Case Classification

Confirmed

An illness characterized by a) two major criteria or one major and two minor criteria (as described in Clinical Description) and b) supporting evidence of preceding group A streptococcal infection.1

Comments

Supporting evidence to confirm streptococcal infection includes increased antistreptolysin-O or other streptococcal antibodies, throat culture positive for group A streptococcus, or recent scarlet fever. 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.

The 1997 case definition appearing on this page was previously published in the 1990 MMWR Recommendations and Reports titled Case Definitions for Public Health Surveillance.2 Thus, the 1990 and 1997 versions of the case definition are identical.

Reference(s)

  1. American Heart Association. Jones criteria (revised) for guidance in the diagnosis of rheumatic fever. Circulation 1984;69:204A-8A.
  2. CDC. (1990). Case Definitions for Public Health Surveillance. MMWR, 39(RR-13), 1-43. https://www.cdc.gov/mmwr/preview/mmwrhtml/00025629.htm


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