RHEUMATIC FEVER
Wisconsin Division of Public Health Disease Surveillance Manual (EpiNet, February 2005)
I. IDENTIFICATION
A. CLINICAL DESCRIPTION: An inflammatory illness that occurs one to five weeks after infection with group A beta-hemolytic streptococcus (GABS). Symptoms of rheumatic fever vary and may include fever, heart failure with shortness of breath, fatigue and cough, joint pain and swelling, nodules under the skin usually located over bony surfaces (elbows, knees, wrists and ankles), rash (erythema marginatum) on the trunk, and Sydenham’s chorea.
B. REPORTING CRITERIA: Clinical diagnosis.
C. LABORATORY CRITERIA FOR CONFIRMATION:
- No specific laboratory test exists for the diagnosis of rheumatic fever.
D. WISCONSIN CASE DEFINITION: An illness characterized by:
- Two major criteria or one major and two minor criteria, AND
- Supporting evidence of preceding Group A Streptococcal infection by one following
methods:
a) Anti-streptococcal antibodies, OR
b) Positive throat culture for GABS, OR
c) Recent scarlet fever,
MAJOR CRITERA MINOR CRITERIA Carditis
Previous rheumatic fever or rheumatic heart disease Polyarthritis
Arthralgia Sydenham’s chorea
Fever Erythema marginatum Elevated erythrocyte sedimentation rate, positive C-reactive protein, or leukocytosis
Prolonged PR interval (ECG)
II. ACTIONS REQUIRED / PREVENTION MEASURES
A. WISCONSIN DISEASE SURVEILLANCE CATEGORY II: Report to the patient's local health officer on an Acute and Communicable Disease Case Report (DPH 4151) or other means within 72 hours of the identification of a case or suspected case.
B. EPIDEMIOLOGY REPORTS REQUESTED: Acute and Communicable Diseases Case Report (DPH 4151).
C. PUBLIC HEALTH INTERVENTIONS:
- Culture symptomatic contacts (See Reference 2).
III. CONTACTS FOR CONSULTATION
A. BCDP / COMMUNICABLE DISEASE EPIDEMIOLOGY SECTION: (608) 267-7321.
B. REGIONAL STAFF: See Epinet Introduction: “REGIONAL OFFICE CONTACTS”.
C. WSLH / ANTI-STREPTOCOCCAL SERUM ANTIBODIES: (608) 262-3217.
IV. RELATED REFERENCES
1. “Streptococcal Pharyngitis” DPH Disease Fact Sheet Series: View a list of all current Communicable Disease Fact Sheets
2. Heymann DL, ed. STREPTOCOCCAL DISEASES CAUSED BY GROUP A (BETA HEMOLYTIC) STREPTOCOCCI. Control of Communicable Diseases Manual. 18 th ed. Washington , DC : American Public Health Association, 2004:507-514.
3. Pickering LK, ed. Secondary Prophylaxis for Rheumatic Fever. In: Red Book: 2003 Report of the Committee on Infectious Diseases. 26 th ed. Elk Grove Village , IL : American Academy of Pediatrics, 2003:582-584.
4. Serious Disease Due to Group A Beta-Hemolytic Streptococci. In: Wisconsin Epidemiology Bulletin (WEB), 1990; 12(1).
V. DISEASE TRENDSThere were no reported cases of rheumatic fever reported in Wisconsin between 1999 and 2003.
Rheumatic Fever Clinical Case Identification Worksheet (based on the Jones Criteria):
Patient Name: ______________________________ Date of Birth: _____/_____/________
Person Completing form: ___________________________ Phone: (____)______-__________
Jones Criteria: If supported by evidence of preceding group A streptococcal infection, the presence of two major manifestations or of one major and two minor manifestations indicates a high probability of acute rheumatic fever.Did the patient have supporting evidence of preceding group A streptococcal infection?
Yes _____ No _____
If yes, was infection indicated by one of the following (circle one):
Positive throat culture or rapid streptococcal antigen test
Elevated or rising streptococcal antibody titer
Major manifestations: (Please circle all that apply)
Carditis
Polyarthritis
Chorea
Erythema marginatum
Subcutaneous nodules
Minor manifestations: (Please circle all that apply)
a) Arthralgia
b) Fever
c) Elevated acute-phase reactants
1. Erythrocyte Sedimentation Rate
2. C-reactive proteind) Prolonged PR interval
Does the case meet the Jones Criteria for diagnosing Rheumatic Fever? Yes ____ No ____
References: Dajani et al: Guidelines for the diagnosis of rheumatic fever, 87:302, 1993.