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
- 近期皮肤感染
- 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
- 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
- D8/17 B 细胞抗原阳性
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
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
利益声明
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
利益声明
JL declares that he has no competing interests.
鸣谢
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.
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. 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
- 澳大利亚关于急性风湿热及风湿性心脏病的预防、诊断和管理指南
- A 族链球菌感染：指导和数据
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风湿热
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