Source: Pedia Platinum 1stEd., + Nelson 20thEd + Doc PB’s LectureJONES Criteria 1992Initial: Hx of strep throat + 2Maj or 1 Maj + 2MinRecurrent:ARF/RHD+GAS+2Major 1Maj+2Minor 3MinMatic: Chorea only; Indolent carditis only;High-risk pop.JONES Criteria 1992 – MAJORJointsArthritis – upward migration – 70%Hot, red, swollen, tenderRespond to salicylates (aspirin)♥HeartCarditis – valvulitis is mostconsistentNodulesHard, painless, nonpruritic, movable-nearbony prominencesErythemamarginatumRare; Nonpruritic, serpiginous orannular rashes w/ pale centers ontrunk (never in face);Disappears in cold,Reappears inwarmSydenham choreaSt. Vitus’ Dance | F>M 8-12 y.o.To elicit: Milkmaid’s grip, spooning& pronation, Wormian darting oftongue, handwriting.JONES Criteria 1992 – MINOR (PEACE)PreviousARFECG w/ PPRProlonged PR: >0.2 sec or >200msArthralgiaJoin pain ONLYLow-risk: PolyarthralgiaHigh-risk: MonoarthralgiaCRP andESRelevatedCRP >3.0 mg/dLESR: Lowrisk: >60 mm/hr |Highrisk: >30 mm/hrElevatedtemperatureLow risk: >38.5 °CHigh-risk: >38 °CASO Titer – elevated if:333 Todd – children | 250 Todd – adultsElevated 2 wks after Strep infxn, peaks at 4-6wks.Preceding infxn if (any):- Increased or rising ASO titer- (+) Throat culture for GAS- (+) Rapid GAS carbohydrate antigen testOpening snapLong, low-pitchedmitral diastolicrumble at apex.IMAGINGCXR:LAE, RVE, prominent PA,Kerley Blines – pulmo.venous congestion & edema.ECG: RVH, LAH, Prominentnotched P waves,A-fib (latecomplication)SRM at apex w/radiation ortransmission tothe left anterioraxillary line.Grade 2-4/6 (vsVSD)IMAGINGECG: Dilated LA &LV, Dilated mitralvalve ring(+) Diastolic thrill3rdLICS-more audible whilesitting/leaningforwardWide PPBounding waterhammer pulse(Corrigan’s sign)IMAGINGCXR: LVE,CardiomegalyDilated ascendingaorta,prominentaortic knob,pulmonarycongestionECG: LVH-usual,LAH-lateHEART SOUNDNew murmur/changingmurmurPE FINDINGSOsler nodes– tender, pea-sized intradermal nodules inhands & toeSplinter hemorrhages–beneath nailsJaneway lesions– painlesssmall erythematous lesionson palm & soleDIAGNOSISBlood culture (2 collections)2D-Echo, DopplerAbsence of vegetationsdoes not exclude IE.Duke CriteriaDefinite:2Maj/1Maj+3Min/5MinMajor Criteria:(+) Bloodculture, Evidence ofendocarditison Echo:- intracardiac mass onvalve/other- regurgitant flow nearprosthesis- abscess- partial dehiscence ofprosthetic v.- new v. regurgitant flowMinor Criteria: see PediaPlat/Trans[no need to memorize, balikankapag nasa practice na – docPB]Remittent fever(40°C, >5d)unresponsive toantibiotics.PLUS atleast 4of theff:- Bulbar conjunctivitis- Strawberry tongue,erythematous oralcavity, & dry crackedlips.- Nonsuppurativecervicallymphadenopathy- Edema & erythema ofhands & feet (acutephase)- PolymorphousexanthemaIf w/ coronary lesions (+fever)– diagnostic alsoAtypical or incomplete- <4 criteria; infants;but other findings arecompatibleClinical PhasesAcute:1-2wks, FeverPerineal desquamationSubacute:After fevergoes down, until 4thwkPeriungual desquam.,Coronary aneurysms,
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cough, Heart murmur
