Diagnosis (Jones Criteria):
MAJOR:
Carditis
- Can affect pericardium, myocardium, endocardium, and epicardium. Pericardium: pleuritic chest pain, pericarditis. Endocardium: usually new mitral regurgitation. Epicardium: Conduction abnormalities. Myocardium: Can mimic myocarditis.
- Knees, elbows, ankles, wrists. Often overlapping and migratory.
- Often unilateral chorea. Emotional lability. Weakness. Sensory change is not seen.
- Evanescent, pink rash with circumsribed borders. Usually on trunk/arms.
- Painless with normal overlying skin on bony surfaces and tendon. A few mm to 1cm in size. Usually 3-4 and symmetric.
Arthralgia
Fever
Elevated CRP
Prolonged PR interval
Diagnosis: 2 major or 1 major 2 minor. Debate as to how sensitive these criteria are -- and they may lead to undertreatment/diagnosis.
Note: At time of diagnosis up to 75% will be culture negative. Usually happens about 2-3 weeks post infection. The ASOT can be helpful (but isn't perfect and many labs don't do it anymore) particularly if it rises with 2 samples taken 2 weeks apart.
See previous blog about peripartum sepsis and toxic shock syndrome including treatment thereof.
See necrotizing fasciitis described in this blog including role of IVIG and prophylaxis of close contacts.