Are there situations in which a diagnosis of Acute Rheumatic Fever might be made without strict adherence to the Jones criteria?
Yes:
1. Isolated chorea many months after the initial streptococcal infection, and serologic evidence of an antecedent infection is lacking.
2. Indolent carditis and/or typical chronic valve lesions (mitral, aortic) may also present as the only manifestation of ARF. The latent period between clinical infection and discovery makes proof of antecedent streptococcal infection difficult.
3. In patients with a history of RHD, recurrent ARF may be difficult to diagnose without development of a different heart lesion; therefore, a presumptive diagnosis based on only one major or one minor criterion may be reasonable.
