Rheumatic fever differential diagnosis
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: João André Alves Silva, M.D. [2]; Anthony Gallo, B.S. [3]
Overview
Rheumatic fever must be differentiated from other diseases that cause fever, skin rash, nausea and fatigue, such as ebola, typhoid fever, malaria, lassa fever, and scarlet fever.
Differentiating Rheumatic Fever from other Diseases
The table below summarizes the findings that differentiate Rheumatic fever from other conditions that cause fever and fatigue:
| Disease | Findings |
|---|---|
| Ebola | Presents with fever, chills vomiting, diarrhea, generalized pain or malaise, and sometimes internal and external bleeding, that follow an incubation period of 2-21 days. |
| Typhoid fever | Presents with fever, headache, rash, gastrointestinal symptoms, with lymphadenopathy, relative bradycardia, cough and leucopenia and sometimes sore throat. Blood and stool culture can confirm the presence of the causative bacteria. |
| Malaria | Presents with acute fever, headache and sometimes diarrhea (children). A blood smears 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. |
| Lassa fever | 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. |
| Yellow fever and other Flaviviridae | Present with 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. |
| Shigellosis & other bacterial enteric infections | Presents with diarrhea, possibly bloody, accompanied by fever, nausea, and sometimes toxemia, vomiting, cramps, and tenesmus. Stools contain blood and mucous in a typical case. A search for possible sites of bacterial infection, together with cultures and blood smears, should be made. Presence of leucocytosis distinguishes bacterial infections from viral infections. |
| Others | Leptospirosis, viral hepatitis, typhus, and mononucleosis can produce signs and symptoms that may be confused with Ebola in the early stages of infection. |