A 7-year-old child presents with fever, migratory arthritis, a new grade 3/6 apical pansystolic murmur, subcutaneous nodules and a skin rash over the trunk. ASO titre is 800 IU/mL. Which Jones criterion is MAJOR in this clinical presentation?
- A Fever
- B Elevated ASO titre
- C Carditis (new murmur of mitral regurgitation) ✓
- D Migratory arthritis
Explanation
The revised Jones criteria (2015) for acute rheumatic fever include five major criteria: carditis (clinical or subclinical/Doppler), polyarthritis, chorea, subcutaneous nodules and erythema marginatum. Migratory polyarthritis is also a major criterion. The question asks which ONE is MAJOR — carditis (new murmur = mitral regurgitation from valvulitis) is the most clinically important major criterion as it determines long-term prognosis. Fever and elevated ASO are minor criteria/supporting evidence. Note: this patient has two major criteria (carditis and polyarthritis) plus supporting streptococcal evidence, satisfying ARF diagnosis.
Reference: Ghai Essential Pediatrics, 10th ed.
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