<?xml version="1.0" encoding="ISO-8859-1"?><article xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance">
<front>
<journal-meta>
<journal-id>2301-1254</journal-id>
<journal-title><![CDATA[Anales de la Facultad de Medicina]]></journal-title>
<abbrev-journal-title><![CDATA[Anfamed]]></abbrev-journal-title>
<issn>2301-1254</issn>
<publisher>
<publisher-name><![CDATA[Universidad de la República. Facultad de Medicina]]></publisher-name>
</publisher>
</journal-meta>
<article-meta>
<article-id>S2301-12542025000101402</article-id>
<article-id pub-id-type="doi">10.25184/anfamed2025v12n1a11</article-id>
<title-group>
<article-title xml:lang="es"><![CDATA[Fiebre reumática aguda: una enfermedad reemergente.]]></article-title>
<article-title xml:lang="en"><![CDATA[Acute Rheumatic Fever: A Reemerging Disease.]]></article-title>
<article-title xml:lang="pt"><![CDATA[Febre reumática aguda: uma doença reemergente.]]></article-title>
</title-group>
<contrib-group>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Macedo]]></surname>
<given-names><![CDATA[Cecilia]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Casuriaga]]></surname>
<given-names><![CDATA[Ana Laura]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Giachetto]]></surname>
<given-names><![CDATA[Gustavo]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
</contrib-group>
<aff id="Af1">
<institution><![CDATA[,Centro Hospitalario Pereira Rossell  ]]></institution>
<addr-line><![CDATA[Montevideo ]]></addr-line>
<country>Uruguay</country>
</aff>
<pub-date pub-type="pub">
<day>00</day>
<month>00</month>
<year>2025</year>
</pub-date>
<pub-date pub-type="epub">
<day>00</day>
<month>00</month>
<year>2025</year>
</pub-date>
<volume>12</volume>
<numero>1</numero>
<copyright-statement/>
<copyright-year/>
<self-uri xlink:href="http://www.scielo.edu.uy/scielo.php?script=sci_arttext&amp;pid=S2301-12542025000101402&amp;lng=en&amp;nrm=iso"></self-uri><self-uri xlink:href="http://www.scielo.edu.uy/scielo.php?script=sci_abstract&amp;pid=S2301-12542025000101402&amp;lng=en&amp;nrm=iso"></self-uri><self-uri xlink:href="http://www.scielo.edu.uy/scielo.php?script=sci_pdf&amp;pid=S2301-12542025000101402&amp;lng=en&amp;nrm=iso"></self-uri><abstract abstract-type="short" xml:lang="es"><p><![CDATA[Resumen  Introducción:  La fiebre reumática aguda (FRA) es una complicacion no supurativa de la infección por Streptococcus pyogenes (SP). En Uruguay, el aumento de la circulación de SP, ha determinado la aparición de casos de FRA.  Objetivo: Describir el caso clínico de una patología que requiere alto índice de sospecha para el diagnóstico.  Caso clínico: Varón 2 años. Consulta por edema y dolor de rodilla y codo derechos de 24 horas de evolución. Fiebre 39.6 ºC axilar el día previo. Niega traumatismos. Rinofaringitis febril, tres semanas previas, recibió amoxicilina cada 8 hs irregularmente.  Examen físico:  edema y calor en rodilla derecha, no rubor. Dolor a la flexo-extensión de codo derecho, sin elementos fluxivos. Hemoglobina 7,7 g/dl anemia normocítica, normocrómica, glóbulos blancos 11.800/mm3, plaquetas 567.000/mm3. Proteína C reactiva 58.5 mg/L. VES 75 mm/h. Ecografía de rodilla: líquido subcuadricipital de 24mm de espesor. Artrocentesis: aspecto turbio, amarillento, sedimento abundante y blanquecino, LDH 267 U/I. Glucosa 0.71 g/L. Ingresa a cuidados moderados con clindamicina iv. Persisten elementos fluxivos en rodilla sin alteración en codo. Cultivo de líquido sinovial, hemocultivo, cultivo faríngeo: sin desarrollo. Anticuerpos anti estreptolisina O (AELO) 10800 UI/ml. Electrocardiograma, ecocardiograma y radiografía de tórax normales. Se plantea fiebre reumática, se indica ácido acetil salicílico (AAS) y penicilina benzatínica intramuscular. Resolución completa de la artritis. Alta con AAS y profilaxis mensual con penicilina benzatínica intramuscular.  Discusión: El diagnóstico de FRA se planteó tras el hallazgo de valores de AELO elevados sumado a un criterio mayor (poliartritis) y 2 menores (fiebre, PCR/VES elevadas). En el contexto epidemiológico actual, resulta necesario sospechar el diagnóstico de FRA, lo que facilitará el diagnóstico precoz y tratamiento adecuado.]]></p></abstract>
<abstract abstract-type="short" xml:lang="en"><p><![CDATA[Abstract  Introduction:  Acute rheumatic fever (ARF) is a nonsuppurative complication of Streptococcus pyogenes (SP) infection. In Uruguay, the increased circulation of SP has led to the re-emergence of ARF.  Objective:  To describe the clinical case of a pathology that requires a high index of suspicion for diagnosis.  Clinical case:  A 2-year-old male presented with swelling and pain in the right knee and elbow of 24 hours' duration. The patient had a fever of 39.6°C (axillary) the previous day. No history of trauma. Three weeks prior, he had febrile rhinopharyngitis and was treated irregularly with amoxicillin every 8 hours.  Physical examination:  Swelling and warmth in the right knee without redness. Pain upon flexion-extension of the right elbow, without inflammatory signs. Analitic: Hemoglobin 7.7 g/dL (normocytic and normochromic anemia), white blood cells 11,800/mm3, platelets 567,000/mm3. C-reactive protein (CRP) 58.5 mg/L, erythrocyte sedimentation rate (ESR) 75 mm/h. Knee ultrasound: 24 mm sub-quadriceps fluid collection. Arthrocentesis: cloudy, yellowish fluid with abundant whitish sediment, LDH 267 U/L, glucose 0.71 g/L. The patient was admitted to moderate care and started on intravenous clindamycin. Fluctuations persisted in the knee without elbow involvement. Synovial fluid culture, blood culture, and bacterial culture of the throat was negative. Antistreptolysin O (ASO) antibodies were 10,800 IU/ml. Electrocardiogram, echocardiogram, and chest X-ray were normal. Following a diagnosis of rheumatic fever, treatment with acetylsalicylic acid (ASA) and intramuscular benzathine penicillin was begun.Complete resolution of arthritis was achieved. The patient was discharged on ASA and monthly prophylaxis with intramuscular benzathine penicillin.  Discussion:  The diagnosis of ARF was based on elevated ASO levels combined with one major criterion (polyarthritis) and two minor criteria (fever, elevated CRP/ESR). In the current epidemiological context, it is necessary to suspect ARF, which will facilitate early diagnosis and appropriate treatment.]]></p></abstract>
<abstract abstract-type="short" xml:lang="pt"><p><![CDATA[Resumo  Introdução:  A febre reumática aguda (FRA) é uma complicação não supurativa da infecção por Streptococcus pyogenes (SP). No Uruguai, o aumento da circulação de SP tem determinado o aparecimento de casos de FRA.  Objetivo:  Descrever o caso clínico de uma patologia que requer um alto índice de suspeição para o diagnóstico.  Caso clínico:  Paciente do sexo masculino, 2 anos. Consulta devido a edema e dor no joelho e cotovelo direitos com 24 horas de evolução. Febre de 39,6 ºC axilar no dia anterior. Nega traumatismos. Rinofaringite febril três semanas antes, recebeu amoxicilina a cada 8 horas de forma irregular.  Exame físico:  edema e calor no joelho direito, sem rubor. Dor à flexoextensão do cotovelo direito, sem sinais de derrame articular. Hemoglobina 7,7 g/dl (anemia normocítica, normocrômica), leucócitos 11.800/mm³, plaquetas 567.000/mm³. Proteína C reativa 58,5 mg/L. VHS 75 mm/h. Ultrassonografia do joelho: líquido subquadricipital de 24 mm de espessura. Artrocentese: aspecto turvo, amarelado, sedimento abundante e esbranquiçado, LDH 267 U/I. Glicose 0,71 g/L. Internado em cuidados moderados com clindamicina intravenosa. Persistência de sinais inflamatórios no joelho, sem alterações no cotovelo. Culturas do líquido sinovial, hemocultura e cultura de orofaringe: sem crescimento bacteriano. Anticorpos antiestreptolisina O (ASLO) 10.800 UI/ml. Eletrocardiograma, ecocardiograma e radiografia de tórax normais. Diagnóstico de febre reumática considerado e iniciado tratamento com ácido acetilsalicílico (AAS) e penicilina benzatina intramuscular. Resolução completa da artrite. Alta com AAS e profilaxia mensal com penicilina benzatina intramuscular.  Discussão:  O diagnóstico de FRA foi estabelecido com base nos altos valores de ASLO, associados a um critério maior (poliartrite) e dois menores (febre, PCR/VHS elevados). No contexto epidemiológico atual, é essencial suspeitar de FRA, o que facilitará o diagnóstico precoce e o tratamento adequado.]]></p></abstract>
<kwd-group>
<kwd lng="es"><![CDATA[Fiebre reumática]]></kwd>
<kwd lng="es"><![CDATA[Streptococcus pyogenes]]></kwd>
<kwd lng="es"><![CDATA[niños]]></kwd>
<kwd lng="en"><![CDATA[Rheumatic fever]]></kwd>
<kwd lng="en"><![CDATA[Streptococcus pyogenes]]></kwd>
<kwd lng="en"><![CDATA[children]]></kwd>
<kwd lng="pt"><![CDATA[Febre reumática]]></kwd>
<kwd lng="pt"><![CDATA[Streptococcus pyogenes]]></kwd>
<kwd lng="pt"><![CDATA[crianças]]></kwd>
</kwd-group>
</article-meta>
</front><back>
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<collab>Sociedad Uruguaya de Pediatría</collab>
<source><![CDATA[Sobre las infecciones por estreptococo en niños, niñas y adolescentes]]></source>
<year>12/1</year>
<month>2/</month>
<day>20</day>
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<label>17</label><nlm-citation citation-type="book">
<collab>Organización Panamericana de la Salud / Organización Mundial de la Salud</collab>
<source><![CDATA[Nota informativa: casos de enfermedades causadas por estreptococos del grupo A en Uruguay]]></source>
<year>2022</year>
<publisher-loc><![CDATA[Washington, D.C ]]></publisher-loc>
<publisher-name><![CDATA[OPS/OMS]]></publisher-name>
</nlm-citation>
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</back>
</article>
