A 9-year-old presents with fever, migratory polyarthritis, and a new pan-systolic murmur at the apex. Anti-streptolysin O (ASO) titre is 800 IU/mL. Echo shows mitral regurgitation. According to 2015 revised Jones criteria, which combination satisfies the diagnosis of Acute Rheumatic Fever (ARF)?
- A Two major criteria (carditis + arthritis) plus evidence of preceding GAS infection ✓
- B One major criterion (carditis) plus two minor criteria plus evidence of GAS infection
- C Three minor criteria alone are sufficient
- D Positive throat culture for GAS alone with fever constitutes ARF diagnosis
Explanation
The 2015 revised Jones criteria require evidence of preceding Group A Streptococcal (GAS) infection PLUS either: (a) two major criteria, or (b) one major + two minor criteria. Major criteria (moderate/high risk populations): carditis (clinical or subclinical/echocardiographic), polyarthritis, Sydenham's chorea, erythema marginatum, subcutaneous nodules. In this patient, carditis (new MR on echo) + migratory polyarthritis = two major criteria, satisfying diagnosis A. Minor criteria include fever, elevated ESR/CRP, prolonged PR interval, and arthralgia (only if arthritis not used as major).
Reference: Ghai Essential Pediatrics, 10th ed.
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Written and medically reviewed by the StethoPrep medical team.