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Clinical presentation of rheumatic fever in an endemic area
  1. Megan P Cann1,
  2. Alan A Sive1,2,
  3. Robert E Norton1,2,
  4. William J H McBride1,3,
  5. Natkunam Ketheesan1
  1. 1James Cook University, Townsville, Queensland, Australia
  2. 2The Townsville Hospital, Townsville, Queensland, Australia
  3. 3Cairns Base Hospital, Cairns, Queensland, Australia
  1. Correspondence to Associate Professor Natkunam Ketheesan, James Cook University, Townsville, Queensland 4811, Australia; n.ketheesan{at}


This study documented whether patients diagnosed with acute rheumatic fever (ARF) in North Queensland, Australia, conformed to the 1992 Revised Jones Criteria (RJC). The authors aimed to determine whether inclusion of subclinical carditis (SCC) and monarthritis as major manifestations and a low-grade temperature as a minor manifestation in the RJC are justified in this population. A retrospective review of patients in whom the diagnosis of ARF relied on the experience of clinicians and who were admitted to the Townsville and Cairns Base Hospitals between 1997 and 2007 was undertaken. Of the 98 cases reviewed, 71.4% satisfied the RJC. Modification of the RJC increased the rate of criteria satisfaction to 91.8%. On presentation, 27 patients had SCC. Of the patients with SCC followed up, 70.5% had long-term valvular consequences. In populations endemic for ARF, monarthritis, SCC and a low-grade temperature should be included in the RJC.

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  • Funding NK's and REN's research on ARF and RHD is partly funded by the National Health and Medical Research Council, Australia (Project Grant 540419).

  • Competing interests None.

  • Ethics approval This study was conducted with the approval of the Townsville and Cairns Health Services District Institutional Ethics Committees.

  • Provenance and peer review Not commissioned; externally peer reviewed.