An.

MZ (11 bulan) Tanda gejala : Sesak nafas memberat sejak 2 minggu Anak batuk berdahak Sesak nafas Sianosis Retraksi dada su ra sterna !ernafasan ireguler Terda at mur"mur# gallo $dema bilateral %adi : &' kali(menit %afas : )*+(menit Suhu ),#- . // : 00 kg

A1ute rheumati1 fe2er (AR3) usuall4 has onset in 1hildhood and o11urs se1ondar4 to infe1tion 5ith 6rou A stre to1o11us (6AS). 7t is an a1ute illness resenting 5ith a 1luster of signs and s4m toms that in1lude 1arditis and ol4arthralgia. 8ithout re2enti2e treatment# AR3 ma4 rogress to 1hroni1 rheumati1 heart disease (R9:) asso1iated 5ith damaged heart 2al2es. Menurut (Arvin , Behrman Klirgman, 2000), streptococcus -hemolyticus grup A merupakan agen pencetus yang menyebabkan terjadinya demam rematik akut 1. !engkajian ersistem kasus demam rematik S4stem muskoloskeletal : n4eri# memar# hangat# kemerahan ada sendi"sendi besar (siku# lutut# Sistem integument : ber1ak kemerahan ada kulit#

Table 1. Australian guidelines for the diagnosis of acute rheumatic fever2

7nitial e isode of AR3

T5o major or one major and t5o minor manifestations $2iden1e of a re1eding 6rou A stre to1o11us infe1tion

Re1urrent atta1k of AR3 Major manifesta tions

T5o major or one major and t5o minor or three minor manifestations

$2iden1e of a re1eding 6rou A stre to1o11us infe1tion

.arditis (in1luding sub1lini1al e2iden1e of rheumati1 2al2e disease on e1ho1ardiogram)

.arditis (in1luding sub1lini1al e2iden1e of rheumati1 2al2e disease on e1ho1ardio gram) !ol4arthriti s S4denham 1horea $r4thema marginatu m Sub1utane ous

!ol4arthritis or ase ti1 mono"arthritis or ol4arthralgia S4denham 1horea $r4thema marginatum Sub1utaneous nodules

nodules 3e2er !ol4arthral gia or ase ti1 mono" Minor $SR ;)* mm(hr or .!R ;)* mg(< arthritis manifesta $SR ;)* tions mm(hr or .!R ;)* !rolonged !"R inter2al on $.6 mg(< !rolonged !"R inter2al on $.6 $SR = er4thro14te sedimentation rate> .R! = 1"rea1tion rotein> $.6 = ele1trogardiogra h Re rodu1ed 5ith ermission :iagnosis and Management of A1ute Rheumati1 3e2er and Rheumati1 9eart :isease in Australia. An e2iden1e based re2ie5. ? %ational 9eart 3oundation of Australia# 2**, 3e2er

Table 3. Clinical features raising a high suspicion of acute rheumatic fever2

Table ). .lini1al features raising a high sus i1ion of a1ute rheumati1 fe2er2 Sore throat in the re2ious 2@, 5eeks 3e2er <etharg4 and m4algia Arthralgia (migrating arthralgia that is as4mmetri1al in attern and affe1ts the large joints) 7ndigenous Australians or !a1ifi1 7slandersA li2ing in 1ro5ded housing 1onditions Migrator4 ol4arthritisB (e+tremel4 ainful# affe1ting large joints) S4denham 1horeaC (in 2-D of 7ndigenous Australians 5ith AR3# es e1iall4 adoles1ent females) Eerk4 mo2ements of hands# feet# tongue and fa1e $+amination .arditis (a i1al ans4stoli1 murmur or earl4 diastoli1 murmur at base of heart) Sub1utaneous nodulesF4en (strong asso1iation 5ith 1arditis)

S4m toms and

$r4thema marginatumG (bright ink ma1ules or a ules on e+tremities or trunk) 3e2er ;)'.*H. !ositi2e ASI and anti":%ase"/ titres Raised .R! ;)* mg(< and $SR ;)* mm(hr <aborator4 marker Transient rolongation of !"R inter2al abo2e *.1,@*.1' se1onds (more likel4 if returning to normal 5ithin 1@2 months) A Signifi1ant ethni1 grou in our urban %S8 stud4 B Mono"arthritis ma4 be a re1urrent resenting feature in high risk o ulations C $1ho1ardiogra h4 is essential for all atients 5ith 1horea JRare but highl4 s e1ifi1 manifestation of AR3 G 9ighl4 s e1ifi1 for AR3 but rare and diffi1ult to dete1t in 7ndigenous Australian atients K L er limit of normal 2aries 5ith age grou Msee Table 2N