Primary episode of rheumatic fever* | Two major or 1 major and 2 minor manifestations plus evidence of a preceding group A streptococcal infection |
Recurrent episode of rheumatic fever in a patient without established rheumatic heart disease† | Two major or 1 major and 2 minor manifestations plus evidence of a preceding group A streptococcal infection |
Recurrent episode of rheumatic fever in a patient with established rheumatic heart disease | Two minor manifestations plus evidence of a preceding group A streptococcal infection‡ |
Rheumatic chorea | Other manifestations or evidence of group A streptococcal infection not required |
Chronic valve lesions of rheumatic heart disease (patients presenting for the first time with pure mitral stenosis or mixed mitral valve disease and aortic valve disease)§ | No other criteria required for diagnosis of rheumatic heart disease |
Major manifestations |
carditis polyarthritis chorea erythema marginatum subcutaneous nodules
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Minor manifestations |
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Supporting evidence of a preceding streptococcal infection within the last 45 d |
electrocardiogram (prolonged P–R interval) elevated or rising antistreptolysin O or other streptococcal antibody titre, or a positive throat culture, or a rapid antigen test for group A streptococci or recent scarlet fever
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