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Febre reumática

  • Visão geral
  • Teoria
  • Diagnóstico
  • Tratamento
  • ACOMPANHAMENTO
  • Recursos
Última revisão: 16 Aug 2025
Última atualização: 10 Apr 2024

Resumo

Definição

História e exame físico

Principais fatores diagnósticos

  • febre
  • dor nas articulações
Detalhes completos

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
Detalhes completos

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
Detalhes completos

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
Detalhes completos

Algoritmo de tratamento

Inicial

monoartrite na febre reumática não confirmada

AGUDA

possível febre reumática

febre reumática confirmada

CONTÍNUA

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

Disclosures

NW declares that he has no competing interests.

Andrea Summer, MD

Assistant Professor of Pediatrics

Medical University of South Carolina

Charleston

SC

Disclosures

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.

References

Our in-house evidence and editorial teams collaborate with international expert contributors and peer reviewers to ensure that we provide access to the most clinically relevant information possible.

Key articles

World Health Organization. Rheumatic fever and rheumatic heart disease: report of a WHO Expert Consultation. 2004 [internet publication].Full text

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.Full text  Abstract

Carapetis JR, Beaton A, Cunningham MW, et al. Acute rheumatic fever and rheumatic heart disease. Nat Rev Dis Primers. 2016 Jan 14;2:15084.Full text  Abstract

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. Abstract

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.Full text  Abstract

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].Full text

Manyemba J, Mayosi BM. Penicillin for secondary prevention of rheumatic fever. Cochrane Database Syst Rev. 2002;(3):CD002227.Full text  Abstract

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].Full text

Reference articles

A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
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