Resumo
Definição
História e exame físico
Principais fatores diagnósticos
- febre
- dor nas articulações
Outros fatores diagnósticos
- faringite ou escarlatina recente
- infecção cutânea recente
- dor torácica
- dispneia
- palpitações
- sopro cardíaco
- atrito pericárdico
- sinais de insuficiência cardíaca
- articulações edemaciadas
- sono agitado
- falta de coordenação
- instabilidade emocional e alterações de personalidade
- movimentos coreiformes descoordenados e espasmódicos
- incapacidade de manter a língua estendida
- mão em ordenha
- sinal da colher
- sinal do pronador
- eritema marginado
- nódulos subcutâneos
- gestação ou uso da pílula contraceptiva oral
Fatores de risco
- pobreza
- áreas residenciais densamente povoadas
- história familiar de febre reumática
- correlação com antígeno leucocitário humano (HLA)
- susceptibilidade genética
- populações indígenas; aborígenes australianos, asiáticos e habitantes das ilhas do Pacífico
- antígeno da célula B D8/17 positivo
Investigações diagnósticas
Primeiras investigações a serem solicitadas
- velocidade de hemossedimentação (VHS)
- proteína C-reativa
- contagem leucocitária
- hemoculturas
- eletrocardiograma
- radiografia torácica
- ecocardiograma
- cultura faríngea
- teste rápido de antígeno para estreptococos do grupo A
- sorologia antiestreptocócica
- teste molecular rápido
Algoritmo de tratamento
monoartrite na febre reumática não confirmada
possível febre reumática
febre reumática confirmada
todos os pacientes após tratamento agudo
Colaboradores
Autores
Liesl Zühlke, MBChB DCH FCPaeds Cert Card (Paeds) MPH FACC FESC MSc PhD
Vice-President South African Medical Research Council - Extramural Research and Internal Portfolio
Director Children's Heart Disease Research Unit
Paediatric Cardiologist, Division of Paediatric Cardiology, Department of Paediatrics
Red Cross Children's Hospital
Cape Heart Institute and Institute of Infectious Diseases and Molecular Medicine
Faculty of Health Sciences
University of Cape Town
Cape Town
South Africa
Declarações
LZ has been funded by the South African Medical Research Council, NRF, and through the African Research Leader award jointly by the UK Medical Research Council (MRC) and the UK Department for International Development (DFID) under the MRC/DFID Concordat agreement. LZ is a board member of the World Heart Federation, the NCD Alliance, and FoodForward South Africa. LZ an author of the UpToDate rheumatic heart disease topic. None of the above are competing interests.
John Lawrenson, null
Head of Clinical Unit
Paediatric Cardiology Service of the Western Cape
Red Cross Children's and Tygerberg Hospital
Stellenbosch University and University of Cape Town
Cape Town
South Africa
Declarações
JL declares that he has no competing interests.
Agradecimentos
Professor Liesl Zühlke and Professor John Lawrenson would like to gratefully acknowledge Dr Rachel Webb, Dr Andrew C. Steer, and Dr Jonathan Carapetis, previous contributors to this topic.
Declarações
RW declares that she has no competing interests; she is an active researcher and clinician in acute rheumatic fever/rheumatic heart disease and is a co-investigator on a (non-industry) grant funded by the Health Research Council of New Zealand and gives educational talks and has prepared manuscripts on rheumatic fever solely in capacity as a University of Auckland academic and Paediatric Infectious Diseases Specialist. ACS and JC declare that they have no competing interests.
Revisores
Salah Zaher, MD
Professor of Pediatrics
Division of Pediatric Cardiology
Faculty of Medicine
University of Alexandria
Cardiologist
El Shatby Children's Hospital
Alexandria
Egypt
Declarações
SZ declares that she has no competing interests.
Nigel Wilson, FRACP
Paediatric Cardiologist/Interventional Cardiologist
Paediatric and Congenital Cardiac Services
Green Lane Clinical Services
Starship Children's Hospital
Auckland
New Zealand
Declarações
NW declares that he has no competing interests.
Andrea Summer, MD
Assistant Professor of Pediatrics
Medical University of South Carolina
Charleston
SC
Declarações
AS declares that she has no competing interests.
Peer reviewer acknowledgements
BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.
Disclosures
Peer reviewer affiliations and disclosures pertain to the time of the review.
Referências
Principais artigos
World Health Organization. Rheumatic fever and rheumatic heart disease: report of a WHO Expert Consultation. 2004 [internet publication].Texto completo
Gewitz MH, Baltimore RS, Tani LY, et al. Revision of the Jones criteria for the diagnosis of acute rheumatic fever in the era of Doppler echocardiography: a scientific statement from the American Heart Association. Circulation. 2015 May 19;131(20):1806-18.Texto completo Resumo
Carapetis JR, Beaton A, Cunningham MW, et al. Acute rheumatic fever and rheumatic heart disease. Nat Rev Dis Primers. 2016 Jan 14;2:15084.Texto completo Resumo
Denny F, Wannamaker LW, Brink WR, et al. Prevention of rheumatic fever; treatment of preceding streptococci infection. J Am Med Assoc. 1950 May 13;143(2):151-3. Resumo
Gerber MA, Baltimore RS, Eaton CB, et al. Prevention of rheumatic fever and diagnosis and treatment of acute streptococcal pharyngitis: a scientific statement from the American Heart Association Rheumatic Fever, Endocarditis, and Kawasaki Disease Committee of the Council on Cardiovascular Disease in the Young, the Interdisciplinary Council on Functional Genomics and Translational Biology, and the Interdisciplinary Council on Quality of Care and Outcomes Research: endorsed by the American Academy of Pediatrics. Circulation. 2009 Mar 24;119(11):1541-51.Texto completo Resumo
RHDAustralia (ARF/RHD writing group). The 2020 Australian guideline for prevention, diagnosis and management of acute rheumatic fever and rheumatic heart disease (3.2 edition, March 2022). 2022 [internet publication].Texto completo
Manyemba J, Mayosi BM. Penicillin for secondary prevention of rheumatic fever. Cochrane Database Syst Rev. 2002;(3):CD002227.Texto completo Resumo
Heart Foundation of New Zealand. New Zealand guidelines for rheumatic fever: diagnosis, management and secondary prevention of acute rheumatic fever and rheumatic heart disease: 2014 update. 2014 [internet publication].Texto completo
Artigos de referência
Uma lista completa das fontes referenciadas neste tópico está disponível para os usuários com acesso total ao BMJ Best Practice.
Diagnósticos diferenciais
- Artrite séptica
- Artrite juvenil
- Artropatia reativa pós-infecciosa
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