A clinical diagnosis of acute rheumatic fever should be made using the Jones Criteria. A 2015 revised version of the Jones Criteria endorsed by ...SkipdirectlytositecontentSkipdirectlytopageoptionsSkipdirectlytoA-ZlinkGroupAStreptococcal(GAS)DiseaseSectionNavigationCDCHomeFacebookTwitterLinkedInSyndicateAcuteRheumaticFeverMinusRelatedPagesOnThisPageEtiologyClinicalFeaturesRiskFactorsDiagnosisandTestingTreatmentPrognosisandComplicationsPreventionEpidemiologyandSurveillanceReferencesAcuterheumaticfeverisadelayedsequelaofpharyngitisduetoStreptococcuspyogenes,whicharealsocalledgroupAStreptococcusorgroupAstrep.Theetiology,clinicalfeatures,diagnosisandtreatmentoptions,prognosisandcomplications,andpreventionaredescribedbelow.EtiologyAcuterheumaticfeverisanonsuppurative,delayedsequelaofpharyngitisduetoS.pyogenes.Theexactdiseaseprocessisnotfullyknown.However,thediseaseisinpartduetoanautoimmuneresponsetoS.pyogenesinfectioninvolvingmultipleorgansystems.Organsystemsinvolvedtypicallyincludetheheart,joints,andcentralnervoussystem.Streptococcalpharyngitistypicallyprecedestheonsetofacuterheumaticfeverby1to5weeks.1S.pyogenesaregram-positivecoccithatgrowinchains(seefigure1).Theyexhibitβ-hemolysis(completehemolysis)whengrownonbloodagarplates.TheybelongtogroupAintheLancefieldclassificationsystemforβ-hemolyticStreptococcus,andthusarealsocalledgroupAstreptococci.Figure1.Streptococcuspyogenes(groupAStreptococcus)onGramstain.Source:PublicHealthImageLibrary,CDCClinicalFeaturesAcuterheumaticfeverisusuallycharacterizedbyfeverandaffectsmultipleorgansystems.CardiovascularSystemCarditisisthemajorcardiacmanifestationofacuterheumaticfever,occurringin50%to70%offirstepisodes,andisassociatedwithvalvulitis.Clinicalsignsofcarditisincludecardiomegaly,newonsetheartmurmur(usuallywithmitraloraorticvalvulardisease),pericardialfrictionrub,pericardialeffusion,andcongestiveheartfailure.Additionally,aprolongedPRintervalcanbeseenonelectrocardiography.Subclinicalcarditismayalsobepresent.Inthesecases,classicmurmur