The differential diagnosis of rheumatic fever

I. Identification of disease with fever and tuberculosis should pay attention to chronic Ganranzao or streptococcus infection, as well as the state of differentiation. Streptococcal infection in the state after streptococcal infection (as flu, tonsillitis or scarlet fever, etc.) after the fever, fatigue weakness, joint Suanteng symptoms. In addition to checks by fast heart rate, heart did not change significantly, there is no rash. ESR by fast and Antistreptolysin-"O" increased. Using low-dose penicillin and adrenal hormone therapy, and soon returned to normal, no longer recurrence. But the performance of these may also be the early rheumatic fever should continue to be closely observed. If the heart or heart murmur increased significantly, and should be considered rheumatic fever. Second, heart (1) functional murmur should first exclude the attention of cardiac function of noise. Such noise was particularly prevalent in the school-age children at the left edge sternum 3-4 intercostal apex medial, generally Ⅱ, Ⅲ up to the individual level. Characterized by a higher pitch, a few music can be a sound, only to shrink as early as mid-conduction is not extensive, no other symptoms of rheumatoid activities. (2) of congenital heart disease such as congenital mitral insufficiency, and some AV access have generally found that the infant period murmur. (C) viral myocarditis recent years there has been an increasing trend. The disease often marked the history of viral upper respiratory tract infection, soon found that heart abnormalities, but no significant noise, and more arrhythmia. Weight can quickly cause severe congestive heart failure and arrhythmia. No arthritis and multiple subcutaneous nodules, and other performance Antistreptolysin-"O" does not generally increased. Third, joints have to identify with the following diseases: (1) of Rheumatology flip-heat, the general situation is good, many involving small joints, for symmetry, migration rarely performance, dual may affect large joints, can cause joint deformities. With cardiac damage minimal. Salicylic acid used in the treatment of rheumatoid arthritis as easy results. (B) in accordance with tuberculosis arthritis history of exposure to tuberculosis, positive tuberculin test is found mostly single-joint involvement, X-ray checks to the main bone destruction and no heart attack, pulmonary tuberculosis often find stoves can be diagnosed. (C) Septic arthritis often the primary pyogenic lesions generally have symptoms of sepsis. Arthritis can start with multiple performance, but soon confined to a joint, red, swelling, heat, pain obvious. A joint cavity puncture wound pus, wound pus and blood culture can be positive, Antistreptolysin-"O" is not high. Late X-ray bone damage. Salicylic acid formulations invalid. (4) acute leukemia sometimes to the early joint disease symptoms, often misdiagnosed as rheumatoid arthritis. But there are obvious leukemia anemia and bleeding, find naive peripheral blood cells, bone marrow, as a leukemia change. (5) TB allergic arthritis (Poncet syndrome) for tuberculosis infection caused by allergic arthritis, tuberculosis symptoms of poisoning, acute they have flip-heat, and erythema nodosum and rheumatism symptoms like arthritis, and rheumatoid arthritis similar. But no cardiac involvement of the disease symptoms, often accompanied herpetic keratitis, the body active TB lesions, a sustained positive tuberculin test. With salicylic acid preparations for the treatment of rheumatoid no significant effect, and effective anti-TB treatment, this is an important diagnostic under, but generally the fastest disappearance of fever, and joint symptoms of erythema nodosum and dissipated slowly. 4, the differential spectrum to be used with spastic distinction, the latter is a single action duplication. Children with scattered attention it will cramps disappeared.