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What is Which one of the following is not Included in Jone's Major criteria - and explain in detail?
Ref: R Alagappan - Manual of Practical Medicine 4th Edition.pg no:146 Jones Criteria for Diagnosis ofRheumatic FeverMajor CriteriaCarditisPancarditis, seen in 50-60% of patients, develops withinthe first 2 weeks of rheumatic fever. Pericarditis isevidenced by presence of a pericardial rub, myocarditisby tachycardia, soft S1, presence of S3 and CCF andendocarditis by the presence of Carey-Coombs' murmur(mitral diastolic murmur).Ahritis (60-75%)Flitting and fleeting type of polyahritis involving largejoints with no residual deformity is seen in 60-75% ofpatients and occurs early in rheumatic fever.Jaccod's ahritis: Ulnar detion of 4th and 5th fingerwith flexion at metacarpophalangeal joints is the only residualdeformity seen in rheumatic polyahritis.Subcutaneous NodulesNon-tender nodules are seen over bony prominenceslike elbows, shin, occiput, spine in 3-5% of patients andoccur 3-6 weeks after onset of rheumatic fever. Patientswho have subcutaneous nodules almost always havecarditis.Erythema Marginatum (< 5% and evanescent)Macular lesions with an erythematous rim and centralclearing in a bathing suit distribution are seen in < 5%of patients and occur early in rheumatic fever.Chorea (Sydenham's Chorea) (2-30%)A neurological disorder with rapid, involuntary andpurposeless non-repetitive movements with a self limitingcourse of 2-6 weeks is more common in females andis a late manifestation of rheumatic fever.