Khriesat Imad, Najada Abdul Hameed
Paediatric Cardiology Unit, Queen Alia Heart Institute, King Hussein Medical Centre, 140440, 11814, Amman, Jordan.
Eur J Pediatr. 2003 Dec;162(12):868-71. doi: 10.1007/s00431-003-1320-x. Epub 2003 Sep 30.
The original Jones criteria, first introduced in 1944, have been modified four times and updated-revised criteria were published in 1992. A variety of clinical manifestations, which may be the presenting signs and symptoms of acute rheumatic fever, are not included in the updated-revised Jones criteria. A retrospective study was conducted on all children previously diagnosed to have acute rheumatic fever between September 1998 and September 2002. Review was focused on clinical presentation; out of 60 medical records reviewed, 4 patients with unusual clinical presentation were recognised and are reported here to highlight the potential diagnostic problems of acute rheumatic fever. They presented with atypical articular involvement, silent carditis and low-grade fever in the presence some time of a positive family history for rheumatic fever.
a high index of suspicion and an awareness of the absence of early carditis are necessary to make the diagnosis of acute rheumatic fever.
最初的琼斯标准于1944年首次提出，已修订四次，1992年公布了更新修订标准。更新修订的琼斯标准未纳入多种可能是急性风湿热首发体征和症状的临床表现。对1998年9月至2002年9月期间所有先前诊断为急性风湿热的儿童进行了一项回顾性研究。重点回顾临床表现；在审查的60份病历中，识别出4例临床表现不寻常的患者，并在此报告以突出急性风湿热潜在的诊断问题。他们表现为非典型关节受累、隐匿性心脏炎以及在有风湿热家族史的情况下持续一段时间的低热。
高度怀疑并意识到早期心脏炎的缺乏对于急性风湿热的诊断很有必要。
