Jones criteria and underdiagnosis of rheumatic fever

Pereira, Breno A. F.; Silva, Nílzio Antônio da; Andrade, Luís Eduardo Coelho; Lima, Flávio Souza; Gurian, Fernanda C.; Netto, Joaquim Caetano de Almeida

doi:10.1007/s12098-007-0001-6

Cited by 23 publications

(20 citation statements)

References 22 publications

(34 reference statements)

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“…In moderate–high risk populations, monoarthritis in addition to the more classic polyarthritis can fulfil a major manifestation 1 . This change is meant to increase the sensitivity of the criteria in areas where ARF remains endemic 24,150,151 and to maintain high specificity in low-risk areas. These modifications were previously reflected in the Australian and New Zealand guidelines, which allow for less-stringent findings among those at greatest risk 152,153 .…”

Section: Diagnosis Screening and Preventionmentioning

confidence: 99%

Acute rheumatic fever and rheumatic heart disease

Carapetis

Beaton

Cunningham

et al. 2016

Nat Rev Dis Primers

429

458

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Acute rheumatic fever (ARF) is the result of an autoimmune response to pharyngitis caused by infection with group A Streptococcus. The long-term damage to cardiac valves caused by ARF, which can result from a single severe episode or from multiple recurrent episodes of the illness, is known as rheumatic heart disease (RHD) and is a notable cause of morbidity and mortality in resource-poor settings around the world. Although our understanding of disease pathogenesis has advanced in recent years, this has not led to dramatic improvements in diagnostic approaches, which are still reliant on clinical features using the Jones Criteria, or treatment practices. Indeed, penicillin has been the mainstay of treatment for decades and there is no other treatment that has been proven to alter the likelihood or the severity of RHD after an episode of ARF. Recent advances — including the use of echocardiographic diagnosis in those with ARF and in screening for early detection of RHD, progress in developing group A streptococcal vaccines and an increased focus on the lived experience of those with RHD and the need to improve quality of life — give cause for optimism that progress will be made in coming years against this neglected disease that affects populations around the world, but is a particular issue for those living in poverty.

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Section: Diagnosis Screening and Preventionmentioning

confidence: 99%

Acute rheumatic fever and rheumatic heart disease

Carapetis

Beaton

Cunningham

et al. 2016

Nat Rev Dis Primers

429

458

View full text Add to dashboard Cite

show abstract

“…And in clinical practice, two situations are observed: (1) patients as having been overdiagnosed with RF, based only on the validity of the positive ASO, causing inadvertent use of penicillin, and are even exposed to the risk of bacterial resistance; (2) patients underdiagnosed, usually by over-reliance on the part of the clinical criteria of Jones, which has high rates of false-negative results [14-16]. Thus, the chronic rheumatic heart disease perpetuates itself as a major public health problem [1, 6].…”

Section: Introductionmentioning

confidence: 99%

Prevalence of Group A Beta-Hemolytic Streptococcus Oropharyngeal Colonization in Children and Therapeutic Regimen Based on Antistreptolysin Levels: Data from a City From Southern Brazil

Merlini¹,

Stocco²,

Schafranski³

et al. 2014

TORJ

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The aim of this study is to determinate the prevalence of oropharyngeal colonization by group A beta-hemolytic Streptococcus (GABHS) in pediatric population of Ponta Grossa, a midsize city of southern Brazil; estimate the effectiveness of antistreptolysin-O (ASO), compared to culture, in presence of infection; and design an unpublished investigative algorithm of rheumatic fever's suspicion, based on needs identified in worldwide consensus. It is an epidemiologic, observational and transversal study, involving 180 children younger than 12 years. Secretion of posterior oropharynx was collected for culture; and peripheral blood for determination of ASO. Student-t and chi-square tests, with Yates correction, were performed for statistical analysis. The ASO cutoff was determined by Receiver Operating Characteristic (ROC) curve. The prevalence encountered was 3.9%, and 25.5% of the children showed reagent ASO. This serological test demonstrated quantitatively and qualitatively significant associations to the GABHS presence (p=0.0001 for both associations) throughout the ROC curve, 200 U Todd was the value that resulted in the best accuracy, demonstrating 100% of sensibility and 80% of specificity in the GAS infection documentation. Also, it was found that the value of 1.200 U represents a specificity of 100%. The results emphasize the need for similar studies in other populations, to provide better targeting of the diagnosis and treatment of oropharyngitis by GABHS, which in turn can prevent up to 80% the cases of rheumatic fever, and consequently, the chronic rheumatic heart disease.

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“…No single specific laboratory test can confirm this diagnosis 7–9. The modified Jones criteria which are less sensitive tend to make cases more easily missed in high-prevalence areas 10,11. This is why this patient was treated as having rheumatic fever.…”

Section: Discussionmentioning

confidence: 99%

Chorea as a First Manifestation in Young Patients with Systemic Lupus Erythematosus who Was Initially Diagnosed with Rheumatic Fever

Albishri

2012

Clin Med Insights Case Rep

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Chorea is a rare manifestation of systemic lupus erythematosus (SLE). We report on a young patient with chorea who was diagnosed initially with rheumatic fever. Follow up and further evaluation confirmed the diagnosis of SLE and anti-phospholipid syndrome. Of special interest were the negative antiphospholipid (aPL) antibodies and the initial diagnosis of rheumatic fever which is still not uncommon problem in our region. The rarity of such presentation with joint and non specific increase of antistreptolysin O (ASO) titer might be the factors that led to an incorrect diagnosis. Early diagnosis and treatment of SLE and anti-phospholipid syndrome are very crucial and should be considered with such presentation.

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Jones criteria and underdiagnosis of rheumatic fever

Cited by 23 publications

References 22 publications

Acute rheumatic fever and rheumatic heart disease

Acute rheumatic fever and rheumatic heart disease

Prevalence of Group A Beta-Hemolytic Streptococcus Oropharyngeal Colonization in Children and Therapeutic Regimen Based on Antistreptolysin Levels: Data from a City From Southern Brazil

Chorea as a First Manifestation in Young Patients with Systemic Lupus Erythematosus who Was Initially Diagnosed with Rheumatic Fever

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