Sergent J S
St. Thomas Hospital, Vanderbilt University, Nashville, Tennessee.
Trans Am Clin Climatol Assoc. 1993;104:15-23; discussion 23-5.
A funny thing has happened on our way to the elimination of rheumatic fever from the United States. It is quite clear that, at least in some areas, rheumatic fever has made a dramatic resurgence. Although all the factors accounting for this are not clearly understood, there are several obvious conclusions that must be drawn: 1. Rheumatic fever is no longer the province of the poor and overcrowded. 2. Clinical manifestations, as embodied in the Jones criteria, may have changed somewhat over the years. 3. New insights into the genetics and immunology of rheumatic fever may lead to a vaccine and/or effective therapy in the future. 4. Rheumatic fever will continue to occur unless and until we resume an aggressive approach to the treatment and prophylaxis of pharyngitis, probably utilizing benzathine penicillin as our primary drug.
在我们致力于在美国消除风湿热的过程中，发生了一件有趣的事情。很明显，至少在某些地区，风湿热已经显著复发。尽管导致这种情况的所有因素尚未完全明了，但有几个明显的结论必须得出：1. 风湿热不再是贫困和拥挤人群的专利。2. 多年来，如琼斯标准所体现的临床表现可能有所变化。3. 对风湿热遗传学和免疫学的新见解可能在未来带来疫苗和/或有效的治疗方法。4. 除非我们恢复积极治疗和预防咽炎的方法，可能主要使用苄星青霉素，否则风湿热将继续发生。
