A 7-year-old child presents with fever, migratory polyarthritis, and a new apical pansystolic murmur. ESR is 85 mm/hr, CRP positive, and ECG shows PR prolongation. Anti-streptolysin O (ASO) titre is 400 IU/mL. What is the Jones criterion classification?

• A One major (arthritis) + two minor criteria (fever + PR prolongation) + evidence of preceding strep infection — diagnosis confirmed
• B One major (carditis) + two minor criteria (fever + elevated CRP/ESR) + ASO evidence — diagnosis confirmed
• C Insufficient criteria; echocardiography needed before diagnosis
• D Two major criteria met (carditis + arthritis) — diagnosis confirmed ✓

Explanation

The Jones Criteria (2015 AHA revision) require either two major or one major + two minor criteria plus evidence of preceding Group A Streptococcal infection. Major criteria: carditis (clinical or subclinical on echo), polyarthritis, chorea, erythema marginatum, subcutaneous nodules. Minor criteria: fever, elevated CRP/ESR, prolonged PR interval. This child has carditis (new murmur) AND migratory polyarthritis as two major criteria, plus elevated ASO — diagnosis of ARF is confirmed without needing echocardiography for diagnosis (though echo is still recommended). Prolonged PR is a minor criterion in the revised Jones criteria.

Reference: Ghai Essential Pediatrics, 10th ed.

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