Table 1. Australian guidelines for the diagnosis of acute rheumatic fever .

Diagnosis	Modified Jones criteria
Definite initial episode of acute rheumatic fever	2 major or 1 major and 2 minor manifestations plus evidence of a preceding group A streptococcal infection*
Definite recurrent episode of acute rheumatic fever in a patient with known past acute rheumatic fever or rheumatic heart disease	2 major or 1 major and 1 minor or 3 minor manifestations, plus evidence of a preceding group A streptococcal infection*
Probable acute rheumatic fever (first episode or recurrence)	A clinical presentation that falls short by either 1 major or 1 minor manifestation, or the absence of streptococcal serology results, but one in which acute rheumatic fever is considered the most likely diagnosis. Such cases should be further categorised according to the level of confidence with which the diagnosis is made: highly suspected acute rheumatic fever uncertain acute rheumatic fever

High-risk groups †		All other groups
Major manifestations	Carditis (including subclinical evidence of rheumatic valvulitis on echocardiogram) Polyarthritis ‡ or aseptic monoarthritis or polyarthralgia Chorea Erythema marginatum Subcutaneous nodules		Carditis (excluding subclinical evidence of rheumatic valvulitis on echocardiogram) Polyarthritis ‡ Chorea Erythema marginatum Subcutaneous nodules
Minor manifestations	Monoarthralgia Fever § ESR ≥30 mm/h or CRP ≥30 mg/L Prolonged P-R interval on ECG #		Polyarthralgia or aseptic monoarthritis Fever § ESR ≥30 mm/h or CRP ≥30 mg/L Prolonged P-R interval on ECG #

^* Evidence includes elevated or rising antistreptolysin O or other streptococcal antibody, or a positive throat culture or rapid antigen test for group A streptococci.

^† High-risk groups are those living in communities with high rates of acute rheumatic fever (incidence >30/100 000 per year in 5–14 year olds) or rheumatic heart disease (all-age prevalence >2/1000). Aboriginal and Torres Strait Islander people living in rural or remote settings are known to be at high risk. Data are not available for other populations, but Aboriginal and Torres Strait Islander people living in urban settings, Maoris and Pacific Islanders, and potentially immigrants from developing countries, may also be at high risk.

^‡ A definite history of arthritis is sufficient to satisfy this manifestation. Note that if polyarthritis is present as a major manifestation, polyarthralgia or aseptic monoarthritis cannot be considered an additional minor manifestation in the same person. Chorea does not require other manifestations or evidence of preceding infection with group A streptococci, provided other causes of chorea are excluded. Care should be taken not to label other rashes, particularly non-specific viral exanthemas, as erythema marginatum.

^§ Fever is defined as oral, tympanic or rectal temperature ≥38 °C on admission, or a reliably reported fever documented during the current illness.

^# If carditis is present as a major manifestation, a prolonged P-R interval cannot be considered an additional minor manifestation.

ESR erythrocyte sedimentation rate

CRP C-reactive protein

Source: Adapted from Table 3.2 of the Australian guideline for prevention, diagnosis and management of acute rheumatic fever and rheumatic heart disease (2nd edition) with permission from RHDAustralia1