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若年成人における急性リウマチ熱の再発
M R Wallace1, P D Garst, T J Papadimos
1Department of Internal Medicine (Infectious Disease Division), Naval Hospital, San Diego, Calif.
JAMA
|November 10, 1989
まとめ
急性リウマチ熱 (ARF) が米国で再発しており,最近,軍人新兵の間で発生しています. 大人発症のARFは重症で,子供以外にもより広範な臨床的疑惑の必要性を強調しています.
科学分野:
- レウマトロジーの病理学
- 感染症疫学 感染症疫学
- 公衆衛生は公衆衛生である.
背景:
- 急性リウマチ熱 (ARF) の発生率は,米国では30年以上にわたって著しく減少しました.
- 最近の散らばったアウトブレイクは,米国の小学生の間でARFの潜在的復活を示唆しています.
- ARF症例の顕著なクラスターは,成人軍人新兵に発生し,重要なイベントをマークしました.
研究 の 目的:
- 軍事基礎訓練を受ける若い成人の男性におけるARF症例のユニークなクラスタリングを報告する.
- このコホートにおける成人発症ARFの臨床表現と重症度を記述する.
- 北米における公衆衛生上の潜在的な問題として,ARFの再出現を強調する.
主な方法:
- ARFと診断された10人の患者の遡及的ケースシリーズ分析.
- 症状,病歴,診断結果を含む臨床データ収集.
- 疫病発生環境の流行病学的調査.
主要な成果:
- サンディエゴの新兵の間で10件のARF症例が特定されました.
- これは20年ぶりに軍人の間で発生した最初の流行であり,10年以上にわたって大人の症例の大きなシリーズを表しています.
- 心炎は30%の患者で発生し,成人のARF発生率と類似しています. すべての患者は重度の多関節炎,貧血,発熱を経験しました. 前回の炎は60%しか報告されていません.
結論:
- 大人発症のARFは重症で,心炎の発生率が高くなります.
- 成人のARFの臨床表現は異なる可能性があり,前回の喉炎の発生率が低いことが報告されています.
- 医療従事者は,喉の痛み歴に関係なく,多関節炎を呈する成人の間で,リウマチ熱の高い疑い指数を維持する必要があります.
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