Rheumatic Fever in Emergency Medicine Differential Diagnoses

1. Pharyngitis (Strep Throat). Centers for Disease Control and Prevention. Available at https://www.cdc.gov/groupastrep/diseases-hcp/strep-throat.html. November 1, 2018; Accessed: July 19. 2021.

2. Bryant PA, Robins-Browne R, Carapetis JR, Curtis N. Some of the people, some of the time: susceptibility to acute rheumatic fever. Circulation. 2009 Feb 10. 119(5):742-53. [QxMD MEDLINE Link].

3. Guilherme L, Kalil J. Rheumatic Fever and Rheumatic Heart Disease: Cellular Mechanisms Leading Autoimmune Reactivity and Disease. J Clin Immunol. 2009 Oct 3. [QxMD MEDLINE Link].

4. Olgunturk R, Okur I, Cirak MY, Oguz AD, Akalin N, Turet S, et al. The role of viral agents in aetiopathogenesis of acute rheumatic fever. Clin Rheumatol. 2011 Jan. 30(1):15-20. [QxMD MEDLINE Link].

5. McDonald M, Currie BJ, Carapetis JR. Acute rheumatic fever: a chink in the chain that links the heart to the throat?. Lancet Infect Dis. 2004 Apr. 4(4):240-5. [QxMD MEDLINE Link].

6. Martin JM, Barbadora KA. Continued high caseload of rheumatic fever in western Pennsylvania: Possible rheumatogenic emm types of streptococcus pyogenes. J Pediatr. 2006 Jul. 149(1):58-63. [QxMD MEDLINE Link].

7. Shulman ST, Tanz RR. Group A streptococcal pharyngitis and immune-mediated complications: from diagnosis to management. Expert Rev Anti Infect Ther. 2010 Feb. 8(2):137-50. [QxMD MEDLINE Link].

8. Steer AC, Carapetis JR. Acute rheumatic fever and rheumatic heart disease in indigenous populations. Pediatr Clin North Am. 2009 Dec. 56(6):1401-19. [QxMD MEDLINE Link].

9. Beaudoin A, Edison L, Introcaso CE, Goh L, Marrone J, Mejia A, et al. Acute rheumatic fever and rheumatic heart disease among children--American Samoa, 2011-2012. MMWR Morb Mortal Wkly Rep. 2015 May 29. 64 (20):555-8. [QxMD MEDLINE Link]. [Full Text].

10. Steer AC, Carapetis JR, Nolan TM, Shann F. Systematic review of rheumatic heart disease prevalence in children in developing countries: the role of environmental factors. J Paediatr Child Health. 2002 Jun. 38(3):229-34. [QxMD MEDLINE Link].

11. Muhamed B, Parks T, Sliwa K. Genetics of rheumatic fever and rheumatic heart disease. Nat Rev Cardiol. 2020 Mar. 17 (3):145-154. [QxMD MEDLINE Link].

12. Lee JL, Naguwa SM, Cheema GS, Gershwin ME. Acute rheumatic fever and its consequences: a persistent threat to developing nations in the 21st century. Autoimmun Rev. 2009 Dec. 9(2):117-23. [QxMD MEDLINE Link].

13. Wang CR, Liu CC, Li YH, Liu MF. Adult-onset acute rheumatic fever: possible resurgence in southern Taiwan. J Clin Radiology. June 2005. 11(3):146-149. [QxMD MEDLINE Link].

14. Olgunturk R, Canter B, Tunaoglu FS, Kula S. Review of 609 patients with acute rheumatic fever in terms of revised and updated Jones criteria. Int J Cardiol. Sep 10 2006. 112(1):91-8. Epub 2005 Dec 20. [QxMD MEDLINE Link].

15. Vijayalakshmi IB, Mithravinda J, Deva AN. The role of echocardiography in diagnosing carditis in the setting of acute rheumatic fever. Cardiol Young. Dec 2005. 15(6):583-8. [QxMD MEDLINE Link].

16. Tavli V, Canbal A, Saylan B, Saritas T, Mese T, Atlihan F. Assessment of myocardial involvement using troponin-I and echocardiography in rheumatic carditis in Izmir, Turkey. Pediatr Int. Feb 2008. 50(1):62-4. [QxMD MEDLINE Link].

17. Steer AC, Kado J, Wilson N, Tuiketei T, Batzloff M, Waqatakirewa L, et al. High prevalence of rheumatic heart disease by clinical and echocardiographic screening among children in Fiji. J Heart Valve Dis. 2009 May. 18(3):327-35; discussion 336. [QxMD MEDLINE Link].

18. Meira ZM, Goulart EM, Colosimo EA, Mota CC. Long term follow up of rheumatic fever and predictors of severe rheumatic valvar disease in Brazilian children and adolscents. Heart. Aug 2005. 91(8):1019-22. [QxMD MEDLINE Link].

19. Parks T, Kado J, Colquhoun S, Carapetis J, Steer A. Underdiagnosis of acute rheumatic fever in primary care settings in a developing country. Trop Med Int Health. 2009 Nov. 14(11):1407-13. [QxMD MEDLINE Link].

20. Pastore S, De Cunto A, Benettoni A, Berton E, Taddio A, Lepore L. The resurgence of rheumatic fever in a developed country area: the role of echocardiography. Rheumatology (Oxford). 2011 Feb. 50(2):396-400. [QxMD MEDLINE Link].

21. Marijon E, Celermajer DS, Tafflet M, El-Haou S, Jani DN, Ferreira B, et al. Rheumatic heart disease screening by echocardiography: the inadequacy of World Health Organization criteria for optimizing the diagnosis of subclinical disease. Circulation. 2009 Aug 25. 120(8):663-8. [QxMD MEDLINE Link].

22. Paulo LT, Terreri MT, Barbosa CM, Len CA, Hilário MO. [Is rheumatic fever a more severe disease in pre-school children?]. Acta Reumatol Port. 2009 Jan-Mar. 34(1):66-70. [QxMD MEDLINE Link].

23. Yee L. Cardiac emergencies in the first year of life. Emerg Med Clin North Am. 2007 Nov. 25(4):981-1008. [QxMD MEDLINE Link].

24. Carapetis JR, Steer AC, Mulholland EK, Weber M. The global burden of group A streptococcal diseases. Lancet Infect Dis. 2005 Nov. 5(11):685-94. [QxMD MEDLINE Link].

25. Wilbur C, Bitnun A, Kronenberg S, Laxer RM, Levy DM, Logan WJ, et al. PANDAS/PANS in childhood: Controversies and evidence. Paediatr Child Health. 2019 May. 24 (2):85-91. [QxMD MEDLINE Link]. [Full Text].

26. [Guideline] Gewitz MH, et al; American Heart Association Committee on Rheumatic Fever, Endocarditis, and Kawasaki Disease of the Council on Cardiovascular Disease in the Young. Revision of the Jones Criteria for the diagnosis of acute rheumatic fever in the era of Doppler echocardiography: a scientific statement from the American Heart Association. Circulation. 2015 May 19. 131 (20):1806-18. [QxMD MEDLINE Link]. [Full Text].

27. Carapetis JR, Currie BJ. Rheumatic fever in a high incidence population: the importance of monoarthritis and low grade fever. Arch Dis Child. Sep 2001. 85(3):223-7. [QxMD MEDLINE Link].

28. Rayamajhi A, Sharma D, Shakya U. Clinical, laboratory and echocardiographic profile of acute rheumatic fever in Nepali children. Ann Trop Paediatr. Sep 2007. 27(3):169-77. [QxMD MEDLINE Link].

29. Karacan M, Isikay S, Olgun H, Ceviz N. Asymptomatic rhythm and conduction abnormalities in children with acute rheumatic fever: 24-hour electrocardiography study. Cardiol Young. 2010 Dec. 20(6):620-30. [QxMD MEDLINE Link].

30. [Guideline] Gerber MA, Baltimore RS, Eaton CB, Gewitz M, Rowley AH, Shulman ST, et al. Prevention of rheumatic fever and diagnosis and treatment of acute Streptococcal pharyngitis: a scientific statement from the American Heart Association Rheumatic Fever, Endocarditis, and Kawasaki Disease Committee of the Council on Cardiovascular Disease in the Young, the Interdisciplinary Council on Functional Genomics and Translational Biology, and the Interdisciplinary Council on Quality of Care and Outcomes Research: endorsed by the American Academy of Pediatrics. Circulation. 2009 Mar 24. 119(11):1541-51. [QxMD MEDLINE Link].

31. Achebe I, Hussain K, Abraham A, Asotibe JC, Shaka H. Acute Rheumatic Fever Presenting as a Mimicker of Septic Arthritis. Cureus. 2020 Jul 27. 12 (7):e9431. [QxMD MEDLINE Link]. [Full Text].

32. Baltimore RS. Re-evaluation of antibiotic treatment of streptococcal pharyngitis. Curr Opin Pediatr. 2010 Feb. 22(1):77-82. [QxMD MEDLINE Link].

33. Kerdemelidis M, Lennon DR, Arroll B, Peat B, Jarman J. The primary prevention of rheumatic fever. J Paediatr Child Health. 2010 Sep. 46(9):534-48. [QxMD MEDLINE Link].

34. Lennon D, Kerdemelidis M, Arroll B. Meta-analysis of trials of streptococcal throat treatment programs to prevent rheumatic Fever. Pediatr Infect Dis J. 2009 Jul. 28(7):e259-64. [QxMD MEDLINE Link].

35. Hashkes PJ, Tauber T, Somekh E, Brik R, Barash J, Mukamel M, et al. Naproxen as an alternative to aspirin for the treatment of arthritis of rheumatic fever: a randomized trial. J Pediatr. 2003 Sep. 143(3):399-401. [QxMD MEDLINE Link].

36. Good MF, Batzloff MR, Pandey M. Strategies in the development of vaccines to prevent infections with group A streptococcus. Hum Vaccin Immunother. 2013 Nov. 9 (11):2393-7. [QxMD MEDLINE Link]. [Full Text].

37. Martin WJ, Steer AC, Smeesters PR, Keeble J, Inouye M, Carapetis J, et al. Post-infectious group A streptococcal autoimmune syndromes and the heart. Autoimmun Rev. 2015 Aug. 14 (8):710-25. [QxMD MEDLINE Link].

38. Kiliç A, Unüvar E, Tatli B, Gökçe M, Omeroglu RE, Oguz F, et al. Neurologic and cardiac findings in children with Sydenham chorea. Pediatr Neurol. 2007 Mar. 36(3):159-64. [QxMD MEDLINE Link].

39. Birdi N, Hosking M, Clulow MK, Duffy CM, Allen U, Petty RE. Acute rheumatic fever and poststreptococcal reactive arthritis: diagnostic and treatment practices of pediatric subspecialists in Canada. J Rheumatol. 2001 Jul. 28(7):1681-8. [QxMD MEDLINE Link].

40. Gerber MA. Rheumatic fever. Kliegman RM, Stanton BF, St. Geme JW, Shor N, Behrman RE eds. Nelson: Textbook of Pediatrics. 19th ed. Philadelphia, PA: Elsevier; 2011. 920-5.

41. Khriesat I, Najada AH. Acute rheumatic fever without early carditis: an atypical presentation. Eur J Pediatrics. Dec 2003. 162(12):868-71. [QxMD MEDLINE Link].

42. Lee GM, Wessels MR. Changing epidemiology of acute rheumatic fever in the United States. Clin Infect Dis. 2006 Feb 15. 42(4):448-50. Epub 2006 Jan 17. [QxMD MEDLINE Link].

43. Ohlsson A, Clark K. Antibiotics for sore throat to prevent rheumatic fever: yes or no? How the Cochrane Library can help. CMAJ. 2004 Sep 28. 171(7):721-3. [QxMD MEDLINE Link].

44. Padmavati S. Rheumatic heart disease: prevalence and preventive measures in the Indian subcontinent. Keywords: rheumatic heart disease; rheumatic fever. Heart. 2001 Aug. 86(2):127. [QxMD MEDLINE Link].

Steven J Parrillo, DO, FACOEP, FACEP Clinical Adjunct Professor, Medical Director and Faculty, Disaster Medicine and Management Masters Program, Philadelphia University College of Health Sciences; Associate Professor, Clinical and Educational Scholarship Track, Jefferson Medical College of Thomas Jefferson University; Director, Division of EMS and Disaster Medicine, Albert Einstein Healthcare Network

Steven J Parrillo, DO, FACOEP, FACEP is a member of the following medical societies: American College of Emergency Physicians, American College of Osteopathic Emergency Physicians, American Osteopathic Association, World Association for Disaster and Emergency Medicine

Disclosure: Nothing to disclose.

Anne Klimke, MD, MS Assistant Professor of Emergency Medicine, Jefferson Medical College of Thomas Jefferson University; Associate Director of EMS Fellowship, Attending Physician, Department of Emergency Medicine, Albert Einstein Medical Center; Attending Physician, Department of Emergency Medicine, Montgomery Hospital Medical Center

Anne Klimke, MD, MS is a member of the following medical societies: American College of Emergency Physicians, National Association of EMS Physicians, Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Gino A Farina, MD, FACEP, FAAEM Professor of Emergency Medicine, Hofstra North Shore-LIJ School of Medicine at Hofstra University; Program Director, Department of Emergency Medicine, Long Island Jewish Medical Center

Gino A Farina, MD, FACEP, FAAEM is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Barry E Brenner, MD, PhD, FACEP Program Director, Emergency Medicine, Einstein Medical Center Montgomery

Barry E Brenner, MD, PhD, FACEP is a member of the following medical societies: Alpha Omega Alpha, American Academy of Emergency Medicine, American College of Chest Physicians, American College of Emergency Physicians, American College of Physicians, American Heart Association, American Thoracic Society, New York Academy of Medicine, New York Academy of Sciences, Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Assaad J Sayah, MD, FACEP President and Chief Executive Officer, Cambridge Health Alliance

Assaad J Sayah, MD, FACEP is a member of the following medical societies: American College of Emergency Physicians, Massachusetts Medical Society

Disclosure: Nothing to disclose.

Robert E O'Connor, MD, MPH Professor and Chair, Department of Emergency Medicine, University of Virginia Health System

Robert E O'Connor, MD, MPH is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, American Heart Association, American Medical Association, National Association of EMS Physicians, Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Catherine V Parrillo, DO, FACOP, FAAP Retired Clinical Assistant Professor, Department of Pediatrics, Philadelphia College of Osteopathic Medicine

Catherine V Parrillo, DO, FACOP, FAAP is a member of the following medical societies: American Academy of Pediatrics, American College of Osteopathic Pediatricians, and American Osteopathic Association

Disclosure: Nothing to disclose.

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