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Rheumatic fever in a high-incidence population : the importance of monoarthritis and low-grade fever

Carapetis, Jonathan R. and Currie, Bart J. (2001). Rheumatic fever in a high-incidence population : the importance of monoarthritis and low-grade fever. Archives of Disease in Childhood,85(3):223-227.

Document type: Journal Article
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Title Rheumatic fever in a high-incidence population : the importance of monoarthritis and low-grade fever
Author Carapetis, Jonathan R.
Currie, Bart J.
Journal Name Archives of Disease in Childhood
Publication Date 2001
Volume Number 85
Issue Number 3
ISSN 1468-2044   (check CDU catalogue open catalogue search in new window)
Start Page 223
End Page 227
Total Pages 5
Place of Publication London
Publisher BMJ
Language English
Field of Research 320000 Medical and Health Sciences
Abstract Aims-To describe the clinical features of rheumatic fever and to assess the Jones criteria in a population and setting similar to that in many developing countries. Methods-The charts of 555 cases of confirmed acute rheumatic fever in 367 patients (97% Aboriginal) and more than 200 possible rheumatic fever cases from the tropical Top End of Australia's Northern Territory were reviewed retrospectively. Results-Most clinical features were similar to classic descriptions. However, monoarthritis occurred in 17% of confirmed non-chorea cases and 35% of unconfirmed cases, including up to 27 in whom the diagnosis was missed because monoarthritis is not a major manifestation. Only 71% and 25% of confirmed non-chorea cases would have had fever using cut off values of 38°C and 39°C, respectively. In 17% of confirmed non-chorea cases, anti-DNase B titres were raised but antistreptolysin O titres were normal. Although features of recurrences tended to correlate with initial episodes, there were numerous exceptions. Conclusions-Monoarthritis and low grade fever are important manifestations of rheumatic fever in this population. Streptococcal serology results may support a possible role for pyoderma in rheumatic fever pathogenesis. When recurrences of rheumatic fever are common, the absence of carditis at the first episode does not reliably predict the absence of carditis with recurrences.
Keywords fever
monoarthritis
population
Rheumatic fever
DOI http://dx.doi.org/10.1136/adc.85.3.223   (check subscription with CDU E-Gateway service for CDU Staff and Students  check subscription with CDU E-Gateway in new window)
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