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

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

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