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
- erythrocyte sedimentation rate (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
Treatment algorithm
Contributors
Authors VIEW ALL
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.
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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