Symptoms of acute rheumatic fever

Diagnosing acute rheumatic fever (ARF) can be challenging as there is no single diagnostic laboratory test – diagnosis is based on clinical decisions plus supporting laboratory evidence. The Jones diagnosis criteria was introduced in 1944 and has been periodically modified and updated in the Australian guideline for prevention, diagnosis and management of ARF and rheumatic heart disease (RHDAustralia 2020). Specific manifestations occurring in ARF that are reliably collected by jurisdictions and are related to an increased risk of rheumatic heart disease (RHD) are presented in this report. These manifestations are:

  • carditis
  • prolonged P-R interval
  • Sydenham chorea (Box 2.1).

People with carditis, a prolonged P-R interval and/or atrioventricular (AV) junctional arrhythmias are more likely to sustain heart damage (and hence to develop RHD) than those without.

Box 2.1: ARF manifestations associated with an increased risk of RHD*

Inflammation of the heart muscle and heart tissue, including the membrane which lines the chambers of the heart and forms the surface of the heart valves (endocardium). It causes a rapid heart rate, fatigue, shortness of breath and exercise intolerance, and in ARF is associated primarily with the mitral valve. Carditis occurs in about 40% to 50% of people with ARF.
Prolonged P-R interval and/or AV junctional arrhythmias
Detected through electrocardiography (ECG). Refers to when the time between specific electrical features of a heartbeat is longer than expected. Often the person has no symptoms.
Sydenham chorea
A neurological disorder, most commonly seen in childhood, resulting from infection with group A beta-haemolytic streptococcus, the bacterium that causes rheumatic fever. It is characterised by involuntary movements of the hands, feet, tongue and face, which stop during sleep. This is more common in females; globally it affects up to 36% of cases and is associated with carditis.

*A complete list of major and minor manifestations of ARF is provided in the Australian guideline for prevention, management and diagnosis of ARF and RHD and in Table T1 of this report.

Source: RHDAustralia 2020.

In 2022, of the 505 ARF diagnoses among First Nations people, 33% had at least one manifestation of carditis, prolonged P-R interval, or Sydenham chorea (Supplementary table 2.6). The inclusion of Sydenham chorea in this value may cause an overestimation of the number of cases at higher risk of progressing to RHD, as it is most often associated with the development of carditis rather than directly with RHD.