Symptoms of febrile illness versus neurologic illness in patients with acute rheumatic fever

Acute febrile illness

Neurologic illness (25 to 30%)

Onset 2 to 4 weeks after GAS infection
Fever is common
Acute joint symptoms and signs
Carditis
- Clinical and subclinical
Skin manifestations and subcutaneous nodules (both are rare)
Raised inflammatory markers
Evidence of preceding GAS infection (elevated ASO and anti-DNase B titers)
Dramatic symptomatic response to aspirin and NSAIDS
Duration usually <6 weeks
Followed by RHD in approximately 75%

Later onset
- Two to 6 months after GAS infection
No fever
Joint manifestations are not a feature
Behavioral disorder and distinctive chorea
Carditis >30%
- Often subclinical
Often normal inflammatory markers
ASO often unhelpful, anti-DNase B may be raised
Followed by RHD in approximately 50%

GAS: group A Streptococcus; ASO: antistreptolysin; NSAID: nonsteroidal antiinflammatory drug; anti-DNase B: antideoxyribonuclease B; RHD: rheumatic heart disease.

Graphic 111437 Version 2.0

خرید پکیج

Symptoms of febrile illness versus neurologic illness in patients with acute rheumatic fever