de Dassel Jessica L, Ralph Anna P, Carapetis Jonathan R
aGlobal and Tropical Health Division, Menzies School of Health Research, Darwin, Australia bInstitute of Advanced Studies, Charles Darwin University, Darwin, Australia cTelethon Kids Institute, Centre for Child Health Research, University of Western Australia, Perth Australia and Department of Paediatric and Adolescent Medicine, Princess Margaret Hospital for Children, Perth, Australia.
Curr Opin Pediatr. 2015 Feb;27(1):116-23. doi: 10.1097/MOP.0000000000000164.
To describe new developments (2013-2014) in acute rheumatic fever (ARF) and rheumatic heart disease (RHD) relevant to developing countries.
Improved opportunities for the primary prevention of ARF now exist, because of point-of-care antigen tests for Streptococcus pyogenes, and clinical decision rules which inform management of pharyngitis without requiring culture results. There is optimism that a vaccine, providing protection against many ARF-causing S. pyogenes strains, may be available in coming years. Collaborative approaches to RHD control, including World Heart Federation initiatives and the development of registers, offer promise for better control of this disease. New data on RHD-associated costs provide persuasive arguments for better government-level investment in primary and secondary prevention. There is expanding knowledge of potential biomarkers and immunological profiles which characterize ARF/RHD, and genetic mutations conferring ARF/RHD risk, but as yet no new diagnostic testing strategy is ready for clinical application.
Reduction in the disease burden and national costs of ARF and RHD are major priorities. New initiatives in the primary and secondary prevention of ARF/RHD, novel developments in pathogenesis and biomarker research and steady progress in vaccine development, are all causes for optimism for improving control of ARF/RHD, which affect the poorest of the poor.
描述与发展中国家相关的急性风湿热（ARF）和风湿性心脏病（RHD）在2013 - 2014年的新进展。
由于针对化脓性链球菌的即时检测抗原试验以及无需培养结果就能指导咽炎管理的临床决策规则，目前存在改善ARF一级预防的机会。人们乐观地认为，一种能预防多种引发ARF的化脓性链球菌菌株的疫苗可能在未来几年问世。包括世界心脏联盟倡议和登记册建立在内的RHD控制协作方法，有望更好地控制这种疾病。关于RHD相关成本的新数据为政府在一级和二级预防方面增加投资提供了有说服力的论据。对表征ARF/RHD的潜在生物标志物和免疫谱以及赋予ARF/RHD风险的基因突变的认识不断扩大，但目前尚无新的诊断测试策略可供临床应用。
降低ARF和RHD的疾病负担及国家成本是主要优先事项。ARF/RHD一级和二级预防的新举措、发病机制和生物标志物研究的新进展以及疫苗开发的稳步推进，都让人们对改善ARF/RHD的控制感到乐观，而ARF/RHD影响着最贫困人群。
