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Rash
Diseases such as Lyme disease and SLE which present with rash may be mistaken for ARF. Lyme disease presents with characteristic rash and arthritis (which appears 1 to 2 months after onset). Juvenile SLE is differentiated by typical skin rash, multiple organ involvement and presence of anti-nuclear antibodies.
Diagnosis
Diagnosis of rheumatic fever is made on basis of various symptoms, signs and results of work up in a case of rheumatic fever (Table 1.2). According to the revised Duckett- Jones criterier, the diagnosis is based upon two or more major clinical manifestations; or and major and two or more minor menifestations. In both cases evidence of previous streptococcal infection is required.
Table Work-up in a Case of Acute Rheumatic Fever Blood Leucocytosis, raised ESR. C-reative protien(raised) ASO titre (raised > 250 units) Throat Throat swab for beta haemolytic streptococci Chest-X-ray Enlarged heart ECG Increased PR interval ( I degree heart block, rarely II and III degree heart block) if pericarditis-low voltage, T-wave inversion Echocardiography For valve abnormality, cardiomegaly and pericar dial effusion
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