Menzies School of Health Research and Charles Darwin University, Darwin, Northern Territory, Australia.
Pediatr Infect Dis J. 2013 Jan;32(1):e26-32. doi: 10.1097/INF.0b013e31826faeb3.
Acute rheumatic fever (ARF) is an important cause of heart disease in Indigenous people of northern and central Australia. However, little is known about ARF in children across all Australian population groups. This national prospective study was conducted to determine patterns of disease, and populations and regions at highest risk.
The Australian Paediatric Surveillance Unit surveillance model was used to collect data on children with ARF across Australia. Children up to 15 years of age were included if they had an ARF episode diagnosed between October 1, 2007 and December 31, 2010 that met the case definition.
ARF was identified in 151 children: 131 Indigenous Australians, 10 non-Indigenous Australians, 8 Pacific Islanders and 1 African (1 unknown). Common presenting features were joint symptoms, fever and carditis. Sydenham chorea was reported in 19% of children. Aseptic monoarthritis was a major manifestation in 19% of high-risk children. Seven non-Indigenous Australian children presented with classic, highly specific features compared with 23% of high-risk children, suggesting that subtle presentations of ARF are being missed in non-Indigenous children. Recent sore throat was reported in 33% of cases, including 25% of remote Indigenous children. There were delays in presentation to care and referral to higher-level care across urban/rural and remote areas.
ARF may be more common than previously thought among low-risk children. These data should prompt an awareness of ARF diagnosis and management across all regions, including strategies for primary prevention. There should be renewed emphasis on treatment of sore throat in high-risk groups.
急性风湿热（ARF）是澳大利亚北部和中部土著居民心脏病的一个重要病因。然而，对于所有澳大利亚人群组的儿童的 ARF 情况知之甚少。本项全国性前瞻性研究旨在确定疾病模式，以及高危人群和地区。
采用澳大利亚儿科监测单位监测模式收集澳大利亚各地的 ARF 患儿数据。2007 年 10 月 1 日至 2010 年 12 月 31 日期间符合病例定义的 15 岁以下 ARF 患儿纳入本研究。
共发现 151 例 ARF 患儿：131 例土著澳大利亚人、10 例非土著澳大利亚人、8 例太平洋岛民和 1 例非洲人（1 例未知）。常见的首发症状为关节症状、发热和心炎。19%的患儿有舞蹈病。高危儿童中 19%有单纯性关节炎。7 例非土著澳大利亚患儿表现为经典、高度特异性的特征，而高危儿童中这一比例为 23%，提示非土著儿童中可能存在 ARF 表现不明显的情况。33%的病例有近期咽痛，包括 25%的偏远地区土著儿童。城乡/偏远地区在就诊和转诊至高级别治疗方面均存在延迟。
ARF 在低危儿童中可能比以前认为的更为常见。这些数据应促使人们在所有地区提高对 ARF 诊断和管理的认识，包括初级预防策略。高危人群中应更加重视咽痛的治疗。
