Zühlke Liesl J, Karthikeyan Ganesan
University of Cape Town and Red Cross War Memorial Children's Hospital, Cape Town, South Africa.
Department of Cardiology, All India Institute of Medical sciences, New Delhi, India.
Glob Heart. 2013 Sep;8(3):221-6. doi: 10.1016/j.gheart.2013.08.005. Epub 2013 Sep 26.
Acute rheumatic fever and rheumatic heart disease are noninfectious sequelae of group A streptococcal pharyngeal infection. These diseases represent a huge public health burden in developing countries with significant mortality and morbidity. Early diagnosis and appropriate antibiotic treatment with group A streptococcal pharyngitis provides an opportunity for prevention of acute rheumatic fever and rheumatic heart disease. The use of locally adapted clinical algorithms for diagnosing group A streptococcal pharyngitis has great potential in resource-poor settings for earlier diagnosis and early treatment. Intramuscular penicillin is the drug of choice in developing country settings. Recent work has demonstrated the cost-effectiveness of a treat-all strategy with intramuscular penicillin, whereas incorporating a clinical decision rule remains the preferred strategy. We strongly support the adoption of a comprehensive prevention and control program for acute rheumatic fever and rheumatic heart disease, incorporating primary prevention, as critical to underpinning the efforts in many parts of the world to stem the tide of this devastating disease.
急性风湿热和风湿性心脏病是A组链球菌咽部感染的非感染性后遗症。在发展中国家，这些疾病造成了巨大的公共卫生负担，死亡率和发病率都很高。对A组链球菌性咽炎进行早期诊断并给予适当的抗生素治疗，为预防急性风湿热和风湿性心脏病提供了机会。在资源匮乏地区，使用因地制宜的临床算法诊断A组链球菌性咽炎，对于早期诊断和早期治疗具有巨大潜力。在发展中国家，肌内注射青霉素是首选药物。最近的研究表明，采用肌内注射青霉素的全面治疗策略具有成本效益，而纳入临床决策规则仍是首选策略。我们强烈支持采用针对急性风湿热和风湿性心脏病的综合预防和控制方案，包括一级预防，这对于支持世界许多地区遏制这种毁灭性疾病的努力至关重要。
