Duckett Jones criteria for diagnosis of rheumatic fever

Required to make the diagnosis

Two major criteria or one major and two miner criteria plus supportive evidence of preceding group A streptococcal infection (markedly raised ASOT titre or group A streptococcus on throat culture)


Major manifestation

a)       Pan carditis- 50%, early manifestation                                                                                                      

                     Endocarditise -murmur

                     Myocarditis    -may lead to heart failure & death

                     Pericarditis- pericardial friction rubs, pericardial effusion, tamponade


b)      Poly arthritis-80%,   early manifestation,  ankle, knee& wrist,  moderate redness

                                 and swelling, migrating to other joint


c)      Sydenham’s chorea- 10%, late manifestation, 2 to 6 month after infection,

                                              involuntary movements, usually ESR/ASOT return to                       

                                             normal at that time.

d)      Erethema marginatum -<5% , uncommon, early manifestation,


e)       Subcutaneous nodules-late manifestation, pain less, mainly on the extensor





    Minor manifestation


a)      Fever

b)      Poly athralgia

c)      History of rheumatic fever

d)      Raised acute reactants- ESR, CRP

e)      Prolonged P-R interval on ECG



In the 3 special categories listed below the diagnosis of rheumatic fever is acceptable without 2 major or 1 major & 2 miner criteria. However for 1 & 2 can the requirement for evidence of a preceding streptococcal infection can be ignored.


1.      Chorea if other causes excluded

2.      Insidious or late onset carditis with no other explanation.

3.      Rheumatic recurrence- In patient with documented rheumatic disease or prior rheumatic fever, the presence of one major criterion or of fever, arthralgia diagnosis of recurrence.



This patient is not presented in acute stage. There fore we can’t diagnosis with criteria. As mention above using exceptions of Duckett Jones criteria we can diagnose.

In echo mitral valve regurgitation and vegetation can be identified. It also shows features of cardiac failure- dilated left ventricle. Congenital mitral regurgitation very rare & it should identify early. Child also didn’t get any symptoms of heart failure. So it should be acquired condition. Matral valve is the most common valve that can affect in rheumatic heart disease.

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