Last reviewed: November 2017
Last updated: November  2017

Summary

Definition

History and exam

Other diagnostic factors

  • recent sore throat or scarlet fever
  • chest pain
  • shortness of breath
  • heart murmur
  • pericardial rub
  • signs of cardiac failure
  • asymmetric joint swelling and/or effusion
  • migratory arthritis
  • restlessness
  • clumsiness
  • emotional lability and personality changes
  • jerky, uncoordinated choreiform movements
  • inability to maintain protrusion of the tongue
  • milkmaid's grip
  • spooning sign
  • pronator sign
  • monoarthritis
  • erythema marginatum
  • subcutaneous nodules
  • pregnancy or taking oral contraceptive pill

Risk factors

  • poverty
  • overcrowded living quarters
  • FHx of rheumatic fever
  • HLA association
  • D8/17 B cell antigen positivity
  • indigenous populations; Aboriginal Australian, Asian, and Pacific Islanders

Diagnostic investigations

1st investigations to order

  • ESR
  • C-reactive protein (CRP)
  • white blood cell count
  • blood cultures
  • ECG
  • chest x-ray
  • echocardiogram
  • throat culture
  • rapid antigen test for group A streptococci
  • anti-streptococcal serology
Full details

Treatment algorithm

Contributors

Authors VIEW ALL

Andrew C. Steer

Associate Professor

General Paediatrician

Paediatric Infectious Diseases Physician

Centre for International Child Health

Department of Paediatrics

University of Melbourne

Royal Children's Hospital

Melbourne

Victoria

Australia

Disclosures

ACS declares that he has no competing interests.

Jonathan Carapetis

Director

Telethon Institute for Child Health Research

Subiaco

Western Australia

Australia

Disclosures

JC declares that he has no competing interests.

Peer reviewers VIEW ALL

Professor of Pediatrics

Division of Pediatric Cardiology

Faculty of Medicine

University of Alexandria

Cardiologist

El Shatby Children's Hospital

Alexandria

Egypt

Disclosures

SZ declares that she has no competing interests.

Paediatric Cardiologist/Interventional Cardiologist

Paediatric and Congenital Cardiac Services

Green Lane Clinical Services

Starship Children's Hospital

Auckland

New Zealand

Disclosures

NW declares that he has no competing interests.

Assistant Professor of Pediatrics

Medical University of South Carolina

Charleston

SC

Disclosures

AS declares that she has no competing interests.

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