Sika-Paotonu Dianne, Beaton Andrea, Raghu Aparna, Steer Andrew, Carapetis Jonathan
Graduate School of Nursing, Midwifery and Health, Victoria University of Wellington, New Zealand; Wesfarmers Centre for Vaccines and Infectious Diseases, Telethon Kids Institute, Perth, Australia
Department of Cardiology, Children’s National Health System, Washington DC, USA
Acute rheumatic fever (ARF) results from the body’s autoimmune response to a throat infection caused by Streptococcus pyogenes, also known as the group A Streptococcus bacteria. Rheumatic heart disease (RHD) refers to the long-term cardiac damage caused by either a single severe episode or multiple recurrent episodes of ARF. It is RHD that remains a significant worldwide cause of morbidity and mortality, particularly in resource-poor settings. While ARF and RHD were once common across all populations, improved living conditions and widespread treatment of superficial S. pyogenes infections have caused these diseases to become comparatively rare in wealthy areas (Carapetis, 2007). Currently, these diseases mainly affect those in low- and middle-income nations, as well as in indigenous populations in wealthy nations where initial S. pyogenes infections may not be treated, which allows for the development of harmful post-infectious sequelae (Carapetis, 2007). The development of ARF occurs approximately two weeks after S. pyogenes infection (Gewitz, et al., 2015). The clinical manifestations and symptoms of ARF can be severe and are described in the Revised Jones Criteria (Gewitz, et al., 2015). Symptoms of ARF can include polyarthritis, carditis, chorea, the appearance of subcutaneous nodules, and erythema marginatum or a rash associated with ARF (Gewitz, et al., 2015; Martin, et al., 2015). These symptoms usually require patients to be hospitalized for two to three weeks, during which time the outward symptoms resolve, but the resultant cardiac damage may persist. With repeated S. pyogenes pharyngitis infections, ARF can recur and cause cumulative damage to the heart valves (Martin, et al., 2015). This chapter will briefly cover the epidemiology and pathophysiology of ARF and RHD, and will also outline the clinical manifestations, diagnostic considerations, and recommended treatment and management options for both conditions. Finally this chapter will also highlight prevention strategies for ARF and RHD and will discuss current vaccination efforts against S. pyogenes.
急性风湿热（ARF）是人体对化脓性链球菌（也称为A组链球菌）引起的咽喉感染产生自身免疫反应的结果。风湿性心脏病（RHD）是指由单次严重发作或多次复发的ARF导致的长期心脏损害。RHD仍然是全球发病和死亡的重要原因，特别是在资源匮乏地区。虽然ARF和RHD曾经在所有人群中都很常见，但生活条件的改善和浅表化脓性链球菌感染的广泛治疗已使这些疾病在富裕地区相对罕见（卡拉佩蒂斯，2007年）。目前，这些疾病主要影响低收入和中等收入国家的人群，以及富裕国家中最初的化脓性链球菌感染可能未得到治疗的原住民，这使得有害的感染后后遗症得以发展（卡拉佩蒂斯，2007年）。ARF大约在化脓性链球菌感染后两周出现（格维茨等人，2015年）。ARF的临床表现和症状可能很严重，在修订的琼斯标准中有描述（格维茨等人，2015年）。ARF的症状可能包括多关节炎、心脏炎、舞蹈病、皮下结节的出现、边缘性红斑或与ARF相关的皮疹（格维茨等人，2015年；马丁等人，2015年）。这些症状通常需要患者住院两到三周，在此期间外在症状会消退，但由此导致的心脏损害可能会持续。随着化脓性链球菌咽炎感染的反复发作，ARF可能会复发并对心脏瓣膜造成累积损害（马丁等人，2015年）。本章将简要介绍ARF和RHD的流行病学和病理生理学，还将概述这两种疾病的临床表现、诊断注意事项以及推荐的治疗和管理方案。最后，本章还将强调ARF和RHD的预防策略，并讨论目前针对化脓性链球菌的疫苗接种工作。
