A 26-year-old man with acute rheumatic fever is being assessed using the revised Jones criteria. He has carditis, polyarthritis, elevated ESR, prolonged PR interval, and documented preceding group A streptococcal infection. How many major and minor criteria does he fulfil?

• A One major and four minor
• B Three major and one minor
• C Two major and two minor ✓
• D Two major and three minor

Explanation

Major Jones criteria are carditis, migratory polyarthritis, chorea, erythema marginatum and subcutaneous nodules; he has carditis and polyarthritis, giving two major. Minor criteria are fever, arthralgia, raised acute phase reactants (ESR or CRP) and prolonged PR interval; he has raised ESR and prolonged PR, giving two minor. Arthritis cannot be counted again as arthralgia once used as a major criterion. With evidence of preceding streptococcal infection, two major plus two minor establishes the diagnosis.

Reference: Nelson Textbook of Pediatrics, 21st ed.

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