Maas Enríquez M, Reyes P A
Arch Inst Cardiol Mex. 1984 Mar-Apr;54(2):153-8.
We compared clinical and immunological characteristics of acute rheumatic fever (19 cases) and infectious endocarditis (7 cases), because these two diseases can be confused easily with each other and their differential diagnosis is not simple. In this small series we had cases of acute rheumatic fever with splenomegaly and/or vasculitis, as well as infectious endocarditis with subcutaneous nodules, which exemplifies the diagnostic problem. Using laboratory tests we were able to point out differences which are statistically significant, such as: rheumatoid factor by passive agglutination of IgG sensitized latex particles (X2 4.27 p less than 0M05), and tests which reflects the presence of circulating immune complexes, hemolytic capacity of antigammaglobulin antibodies (X2 3.79 p less than 0.05) and the presence of circulating C3 degradation products (X2 5.92 p less than 0.01), which occurs preferentially or exclusively in infectious endocarditis. Although in the standard patient the clinical assessment is usually sufficient to establish a diagnosis, when differentiation between acute rheumatic fever and infectious endocarditis is not clear, immunologic tests are helpful.
我们比较了急性风湿热（19例）和感染性心内膜炎（7例）的临床和免疫学特征，因为这两种疾病容易相互混淆，且它们的鉴别诊断并不简单。在这个小样本系列中，我们有出现脾肿大和/或血管炎的急性风湿热病例，以及伴有皮下结节的感染性心内膜炎病例，这例证了诊断问题。通过实验室检测，我们能够指出具有统计学意义的差异，例如：通过IgG致敏乳胶颗粒被动凝集法检测类风湿因子（X2 4.27，p小于0.05），以及反映循环免疫复合物存在的检测、抗丙种球蛋白抗体的溶血能力（X2 3.79，p小于0.05）和循环C3降解产物的存在（X2 5.92，p小于0.01），这些情况优先或仅发生在感染性心内膜炎中。虽然在标准患者中，临床评估通常足以确立诊断，但当急性风湿热和感染性心内膜炎之间的鉴别不明确时，免疫学检测会有所帮助。
