Rash
Diseases such as Lyme disease and SLE which present with rash may be mistaken for ARF. Lyme disease presents with characteristic rash and arthritis (which appears 1 to 2 months after onset). Juvenile SLE is differentiated by typical skin rash, multiple organ involvement and presence of anti-nuclear antibodies.
Diagnosis
Diagnosis of rheumatic fever is made on basis of various symptoms, signs and results of work up in a case of rheumatic fever (Table 1.2). According to the revised Duckett- Jones criterier, the diagnosis is based upon two or more major clinical manifestations; or and major and two or more minor menifestations. In both cases evidence of previous streptococcal infection is required.
Table Work-up in a Case of Acute Rheumatic Fever
Blood Leucocytosis, raised ESR. C-reative protien(raised)
ASO titre (raised > 250 units)
Throat Throat swab for beta haemolytic streptococci
Chest-X-ray Enlarged heart
ECG Increased PR interval ( I degree heart block, rarely II and III degree heart block) if pericarditis-low
voltage, T-wave inversion
Echocardiography For valve abnormality, cardiomegaly and pericar dial effusion