Keitzer R
Klinik für Pädiatrie mit Schwerpunkt Pneumologie und Immunologie, Charité-Universitätsmedizin Berlin, Augustenburger Platz 1, 13353 Berlin.
Z Rheumatol. 2005 Jun;64(5):295-307. doi: 10.1007/s00393-005-0749-x.
Betahemolytic strains of streptococcus A are able to induce a spectrum of immunologically induced diseases, depending on the immunogenic M structure of the bacteria as well as on the genetic determined reaction of the host. In acute rheumatic fever (ARF) the Jones criteria, revised and modified several times and updated in 1992, remain the diagnostic standard. Echocardiography, still not included in the Jones criteria, has become a very important diagnostic tool, especially as half of the ARF induced carditis cases are clinically inapparent. Diagnosis may be very difficult if arthritis is the only major sign, especially if not occurring in the typical migrating pattern, a fact frequently reported from countries with a high risk of ARF. Poststreptococcal reactive arthritis (PSRA) has been described as a different entity as well as a part of rheumatic fever. There is a lack of validated diagnostic criteria to establish a reliable diagnosis. There are no accepted recommendations for antibiotic prophylaxis in PSRA.
A组β溶血性链球菌菌株能够引发一系列免疫诱导性疾病，这取决于细菌的免疫原性M结构以及宿主的基因决定反应。在急性风湿热（ARF）中，琼斯标准经过多次修订和修改，并于1992年更新，仍然是诊断标准。超声心动图虽仍未纳入琼斯标准，但已成为一项非常重要的诊断工具，尤其是因为一半的ARF诱发的心脏炎病例临床上并不明显。如果关节炎是唯一的主要症状，诊断可能会非常困难，特别是如果不是以典型的游走性模式出现，这一情况在ARF高风险国家经常有报道。链球菌感染后反应性关节炎（PSRA）已被描述为一种不同的病症以及风湿热的一部分。缺乏经过验证的诊断标准来建立可靠的诊断。对于PSRA的抗生素预防没有公认的建议。
