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| ==Differentiating Rheumatic Fever from Other Diseases== | | ==Differentiating Rheumatic Fever from Other Diseases== |
| Rheumatic fever must be differentiated from:<ref name="WHO"> Rheumatic Fever and Rheumatic Heart Disease. World Health Organization (2004). http://www.who.int/cardiovascular_diseases/resources/en/cvd_trs923.pdf Accessed on October 12, 2015. </ref>
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| ! style="background: #4479BA; width: 120px;" | {{fontcolor|#FFF|Disease}}
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| ! style="background: #4479BA; width: 550px;" | {{fontcolor|#FFF|Findings}}
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| | style="padding: 5px 5px; background: #DCDCDC;" | '''[[Typhoid fever]]'''
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| | style="padding: 5px 5px; background: #F5F5F5;" | Presents with [[fever]], [[headache]], [[rash]], gastrointestinal symptoms, with [[lymphadenopathy]], relative [[bradycardia]], [[cough]] and [[leukopenia]] and [[sore throat]]. [[Blood]] and [[stool culture]] can confirm the presence of the causative bacteria.
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| | style="padding: 5px 5px; background: #DCDCDC;" |'''[[Malaria]]'''
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| | style="padding: 5px 5px; background: #F5F5F5;" |Presents with acute [[fever]], [[headache]] and [[diarrhea]] (children). A [[blood smear]]s must be examined for malaria parasites. The presence of [[parasites]] does not exclude a concurrent viral infection. An [[antimalarial]] should be prescribed as an [[empiric therapy]].
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| | style="padding: 5px 5px; background: #DCDCDC;" | '''[[Lassa fever]]'''
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| | style="padding: 5px 5px; background: #F5F5F5;" |Disease onset is usually gradual, with [[fever]], [[sore throat]], [[cough]], [[pharyngitis]], and [[facial edema]] in the later stages. [[Inflammation]] and exudation of the [[pharynx]] and [[conjunctiva]] are common.
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| | style="padding: 5px 5px; background: #DCDCDC;" | '''[[Yellow fever]] and other [[Flaviviridae]] '''
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| | style="padding: 5px 5px; background: #F5F5F5;" | Present with [[hemorrhage|hemorrhagic]] complications. [[Epidemiological]] investigation may reveal a pattern of disease [[transmission]] by an insect vector. Virus isolation and serological investigation serves to distinguish these [[viruses]]. Confirmed history of previous [[yellow fever]] [[vaccination]] will rule out [[yellow fever]].
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| | style="padding: 5px 5px; background: #DCDCDC;" | '''[[Shigellosis]] & other bacterial enteric infections'''
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| | style="padding: 5px 5px; background: #F5F5F5;" | Presents with [[diarrhea]], possibly [[Dysentery|bloody]], accompanied by [[fever]], [[nausea]], and [[toxemia]], [[vomiting]], [[cramps]], and [[tenesmus]]. [[Stool]]s contain [[blood]] and mucous in a typical case. A search for possible sites of bacterial infection, together with cultures and [[blood smear]]s, should be made. Presence of [[leukocytosis]] distinguishes bacterial infections from [[viral infections]].
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| | style="padding: 5px 5px; background: #DCDCDC;" | '''[[Ebola]]'''
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| | style="padding: 5px 5px; background: #F5F5F5;" | Presents with [[fever]], [[chills]] [[vomiting]], [[diarrhea]], generalized [[pain]] or [[malaise]], and [[Internal bleeding|internal]] and external [[bleeding]], that follow an [[incubation period]] of 2-21 days.
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| | style="padding: 5px 5px; background: #DCDCDC;" | '''Others'''
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| | style="padding: 5px 5px; background: #F5F5F5;" |[[Scarlet fever]], [[leptospirosis]], [[viral hepatitis]], [[typhus]], and [[mononucleosis]] can produce [[signs]] and [[symptoms]] that may be confused with rheumatic fever in early stages of infection.
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| Rheumatic fever must be differentiated from other causes of rash and arthritis<ref name="pmid3101626">{{cite journal| author=Rompalo AM, Hook EW, Roberts PL, Ramsey PG, Handsfield HH, Holmes KK| title=The acute arthritis-dermatitis syndrome. The changing importance of Neisseria gonorrhoeae and Neisseria meningitidis. | journal=Arch Intern Med | year= 1987 | volume= 147 | issue= 2 | pages= 281-3 | pmid=3101626 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=3101626 }} </ref><ref name="pmid16297736">{{cite journal| author=Rice PA| title=Gonococcal arthritis (disseminated gonococcal infection). | journal=Infect Dis Clin North Am | year= 2005 | volume= 19 | issue= 4 | pages= 853-61 | pmid=16297736 | doi=10.1016/j.idc.2005.07.003 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16297736 }} </ref><ref name="pmid22353959">{{cite journal| author=Bleich AT, Sheffield JS, Wendel GD, Sigman A, Cunningham FG| title=Disseminated gonococcal infection in women. | journal=Obstet Gynecol | year= 2012 | volume= 119 | issue= 3 | pages= 597-602 | pmid=22353959 | doi=10.1097/AOG.0b013e318244eda9 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22353959 }} </ref>
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| | style="padding: 5px 5px; background: #DCDCDC;" |'''Nongonococcal [[septic arthritis]]'''
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| | style="padding: 5px 5px; background: #F5F5F5;" |
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| *Presents with an acute onset of joint swelling and pain (usually monoarticular)
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| *Culture of joint fluid reveals organisms
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| | style="padding: 5px 5px; background: #DCDCDC;" | '''[[Acute rheumatic fever]]'''
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| | style="padding: 5px 5px; background: #F5F5F5;" |
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| *Presents with polyarthritis and rash (rare presentation) in young adults. Microbiologic or serologic evidence of a recent streptococcal infection confirm the diagnosis.
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| *Poststreptococcal arthritis have a rapid response to [[salicylate]]s or other [[antiinflammatory drugs]].
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| | style="padding: 5px 5px; background: #DCDCDC;" |'''[[Syphilis]]'''
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| | style="padding: 5px 5px; background: #F5F5F5;" |
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| *Presents with acute secondary syphilis usually presents with generalized, pustular lesions at the palms and soles with [[lymphadenopathy|generalized lymphadenopathy]]
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| *Rapid plasma reagin (RPR), Venereal Disease Research Laboratory (VDRL) and Fluorescent treponemal antibody absorption (FTA-ABS) tests confirm the presence of the causative agent.
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| | style="padding: 5px 5px; background: #DCDCDC;" | '''[[Reactive arthritis]] (Reiter syndrome)'''
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| | style="padding: 5px 5px; background: #F5F5F5;" |
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| *Musculoskeletal manifestation include [[arthritis]], [[tenosynovitis]], [[dactylitis]], and low back pain.
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| *Extraarticular manifestation include [[conjunctivitis]], [[urethritis]], and genital and oral lesions.
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| *Reactive arthritis is a clinical diagnosis based upon the pattern of findings and there is no definitive diagnostic test
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| | style="padding: 5px 5px; background: #DCDCDC;" | '''[[Hepatitis B virus|Hepatitis B virus (HBV) infection]]'''
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| | style="padding: 5px 5px; background: #F5F5F5;" |
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| *Presents with fever, chills, polyarthritis, [[tenosynovitis]], and [[urticarial|urticarial rash]]
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| *Synovial fluid analysis usually shows noninflammatory fluid
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| *Elevated [[aminotransaminases|serum aminotransaminases]] and evidence of acute HBV infection on serologic testing confirm the presence of the HBV.
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| | style="padding: 5px 5px; background: #DCDCDC;" | '''[[Herpes simplex virus|Herpes simplex virus (HSV)]]'''
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| | style="padding: 5px 5px; background: #F5F5F5;" |
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| *Genital and extragenital lesions can mimic the skin lesions that occur in disseminated gonococcal infection
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| *Viral culture, [[polymerase chain reaction|polymerase chain reaction (PCR)]], and direct fluorescence antibody confirm the presence of the causative agent.
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| | style="padding: 5px 5px; background: #DCDCDC;" | '''[[HIV infection]] '''
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| | style="padding: 5px 5px; background: #F5F5F5;" |
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| *Present with generalized rash with mucus membrane involvement, fever, chills, and [[arthralgia]]. Joint effusions are uncommon
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| | style="padding: 5px 5px; background: #DCDCDC;" | '''[[Gout|Gout and other crystal-induced arthritis]]'''
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| | style="padding: 5px 5px; background: #F5F5F5;" |
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| *Presents with acute monoarthritis with fever and chills
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| *Synovial fluid analysis confirm the diagnosis.
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| | style="padding: 5px 5px; background: #DCDCDC;" | '''[[Lyme disease]]'''
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| | style="padding: 5px 5px; background: #F5F5F5;" |
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| *Present with erythema chronicum migrans rash and [[monoarthritis]] as a later presentation.
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| *Clinical characteristics of the rash and and serologic testing confirm the diagnosis.
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| ==References== | | ==References== |