小结
定义
病史和体格检查
关键诊断因素
- 发热
- 关节痛
其他诊断因素
- 近期咽痛或猩红热
- 胸痛
- 呼吸短促
- 心悸
- 心脏杂音
- 心包摩擦音
- 心力衰竭的体征
- 关节肿胀
- 烦躁不安
- 笨拙
- 情绪不稳和人格改变
- 抽动性、不协调的舞蹈样运动
- 不能保持舌部伸出
- 挤奶工手法
- 匙样征
- 旋前肌征
- 环形红斑
- 皮下结节
- 妊娠或服用口服避孕药
危险因素
- 贫穷
- 居住拥挤
- 风湿热家族史
- D8/17 B 细胞抗原阳性
- 人类白细胞抗原 (HLA) 相关性
- 遗传易感性
- 土著居民；澳大利亚、亚洲和太平洋岛的土著居民
诊断性检查
首要检查
- 红细胞沉降率 (ESR)
- C 反应蛋白 (CRP)
- 白细胞计数
- 血液培养
- 心电图
- 胸部 X 线检查
- 超声心动图
- 咽培养
- A 族链球菌抗原快速检测
- 抗链球菌血清学检查
- 快速分子检测
治疗流程
未证实风湿热的单关节炎
疑似风湿热
确诊的风湿热
所有完成急性期治疗的患者
撰稿人
作者
Rachel Webb, MbChB, MPH & THM, FRACP
Senior Lecturer in Paediatrics
University of Auckland
Paediatric Infectious Diseases Specialist
Starship Children's Hospital and Middlemore Hospital
Auckland
New Zealand
利益声明
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.
鸣谢
Dr Rachel Webb would like to gratefully acknowledge Dr Andrew C. Steer and Dr Jonathan Carapetis, previous contributors to this topic.
利益声明
ACS and JC declare that they have no competing interests.
同行评议者
Salah Zaher, MD
Professor of Pediatrics
Division of Pediatric Cardiology
Faculty of Medicine
University of Alexandria
Cardiologist
El Shatby Children's Hospital
Alexandria
Egypt
利益声明
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
利益声明
NW declares that he has no competing interests.
Andrea Summer, MD
Assistant Professor of Pediatrics
Medical University of South Carolina
Charleston
SC
利益声明
AS declares that she has no competing interests.
鉴别诊断
- 化脓性关节炎
- 青少年关节炎
- 感染后反应性关节病
更多 鉴别诊断指南
- 澳大利亚急性风湿热及风湿性心脏病的预防、诊断和治疗指南（第 3 版）
- A 族链球菌感染：指导和数据
更多 指南患者教育信息
风湿热
更多 患者教育信息
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