SPECIAL ARTICLE

PEDIATRICS ◽  
1955 ◽  
Vol 15 (5) ◽  
pp. 642-646
Keyword(s):  
General Population ◽  
Rheumatic Fever ◽  
Streptococcal Infection ◽  
Acute Otitis Media ◽  
Clinical Manifestations ◽  
Diagnostic Errors ◽  
White Blood Count ◽  
Streptococcal Infections ◽  
Laboratory Findings ◽  
Adequate Treatment

RHEUMAT1C fever is a recurrent disease which in most instances can be prevented. Since both the initial and recurrent attacks of the disease are precipitated by infections with beta hemolytic streptococci, prevention of rheumatic fever and rheumatic heart disease depends upon the control of streptococcal infections. This may be accomplished by (1) early and adequate treatment of streptococcal infections in all individuals and (2) prevention of streptococcal infections in rheumatic subjects. TREATMENT OF STREPTOCOCCAL INFECTIONS IN THE GENERAL POPULATION In the general population about 3 per cent of untreated streptococcal infections are followed by rheumatic fever. Adequate and early penicillin treatment, however, will eliminate streptococci from the throat and prevent most attacks of rheumatic fever. Diagnosis of Streptococcal Infection In many instances streptococcal infections can be recognized by their clinical manifestations. In some patients, however, it is difficult or impossible to determine the streptococcal nature of a respiratory infection without obtaining throat cultures. The following section on diagnosis has been included in order to reduce diagnostic errors and to assist physicians in avoiding unnecessary therapy. The accurate recognition of individual streptococcal infections, their adequate treatment and the control of epidemics in the community presently offer the best means of preventing initial and recurrent rheumatic fever. Common Symptoms Sore Throat—sudden onset, pain on swallowing. Headache—common. Fever—variable, but generally from 101° to 104°F. Abdominal Pain—common, especially in children; less common in adults. Nausea and Vomiting—common, especially in children. Common Signs Red Throat. Exudate—usually present. Glands—swollen, tender lymph nodes at angle of jaw. Rash—scarlatiniform. Acute Otitis Media and Acute Sinusitis —frequently due to the streptococcus. In the absence of the common symptoms and signs occurrence of any of the following symptoms is usually not associated with a streptococcal infection : simple coryza; hoarseness; cough. Laboratory Findings White Blood Count—generally over 12,000. Throat Culture—positive culture for hemolytic streptococci is almost always diagnostic.

STUDIES IN THE RELATION OF THE HEMOLYTIC STREPTOCOCCUS TO RHEUMATIC FEVER

PEDIATRICS ◽  
1949 ◽  
Vol 3 (4) ◽  
pp. 482-503
Author(s):  
T. N. HARRIS ◽  
SUSANNA HARRIS ◽  
RUTH L. NAGLE
Keyword(s):  
Rheumatic Fever ◽  
Streptococcal Infection ◽  
Laboratory Diagnosis ◽  
Diagnostic Value ◽  
The Other ◽  
Streptococcal Infections ◽  
Hemolytic Streptococcus ◽  
Streptococcal Antigens ◽  
The Mean

Titrations of antibodies to four streptococcal antigens have been carried out in the sera of patients with rheumatic fever and of convalescents from streptococcal infections. These antigens are the hyaluronidase, the hemolysin, and two somatic fractions, the cytoplasmic particles and supernate proteins. Mean titers to all of these antigens were elevated in both rheumatic and streptococcal infection. The mean titer was somewhat higher in rheumatic than in streptococcal infection in the case of three of these antibodies. In the case of the fourth, antihyaluronidase, this difference was considerably greater. The antihyaluronidase titer showed better correlation with changes in the activity of the rheumatic infection than did the other tests. There was, however, no striking correlation between this titer and the severity of the illness. Application was made of these findings to the problem of laboratory diagnosis of rheumatic fever by streptococcal serology. A method is presented for assessing the relative usefulness of such tests in terms of the, distribution of their titers in this disease and in health. By this method the antihyaluronidase test was found to be most useful of the four. The comparative diagnostic value for rheumatic fever was studied in the case of the antihyaluronidase test, the antistreptolysin test, and of combinations of both tests.

Possible Influence of Geographic Location and Colony Counts on Guidelines for Diagnosis of Streptococcal Infections in Rheumatic Fever

PEDIATRICS ◽  
1972 ◽  
Vol 49 (4) ◽  
pp. 636-636
Author(s):  
Norman Lewak
Keyword(s):  
Rheumatic Fever ◽  
Medical Practice ◽  
Streptococcal Infection ◽  
Geographic Location ◽  
Economic Factors ◽  
Streptococcal Infections ◽  
The Public ◽  
The Future

In their "Guidelines for the Diagnosis of Streptococcal Infection" (Pediatrics, 48:573, 1971), Honikman and Massell did not specify whether the guidelines should vary by geographic location. Taking into consideration the economic factors mentioned by the authors, should the same guidelines apply to different areas of the country which have markedly different incidences of rheumatic fever? We are all aware that the public is (rightfully) taking a close look at the quality of medical practice. Practice audits appear to be a certainty in the future.

scholarly journals A study of rheumatic fever and streptococcal infection in different social groups in Melbourne

1953 ◽  
Vol 51 (4) ◽  
pp. 450-457 ◽  
Author(s):  
Margaret C. Holmes ◽  
Sydney D. Rubbo
Keyword(s):  
Rheumatic Fever ◽  
Streptococcal Infection ◽  
Throat Swab ◽  
Social Groups ◽  
Carrier Rate ◽  
Streptococcal Infections ◽  
The Social ◽  
Social Distribution ◽  
The Many ◽  
The University

1. Hospital records of 1469 cases of rheumatic fever (including chorea) up to the age of 14 years were used to study the social distribution of the disease in Melbourne. On this evidence the incidence of rheumatic fever was three times greater in low than in high rental districts.2. The results of throat-swab surveys and Dick tests on schoolchildren living in different districts showed that children in the poor districts contracted streptococcal infections more frequently than those in well-to-do districts.3. One factor associated with the carrier rate ofStreptococcus pyogenesin the various social groups was the incidence of tonsillectomy. In the better class districts where the tonsillectomy rate was high (60%) theStr. pyogenescarrier rate was 12.5%, whereas the rates in poor areas were 35 and 25.3% respectively.4. Differences in social incidence of rheumatic fever might therefore be explained by differences in social incidence of streptococcal infection, which, in turn, might be influenced by the incidence of tonsillectomy.We wish to thank the many persons who so willingly assisted in the collection of data for this study, particularly Dr H. L. Stokes and Dr M. M. Wilson, and Dr R. E. O. Williams for advice on presentation. This work was supported by a grant to one of us (Dr M. C. Holmes) from the Commonwealth Research Fund from the University of Melbourne.

EVALUATION OF THE STREPTOCOCCAL DESOXYRIBO-NUCLEASE B AND DIPHOSPHOPYRIDINE NUCLEOTIDASE ANTIBODY TESTS IN ACUTE RHEUMATIC FEVER AND ACUTE GLOMERULONEPHRITIS

PEDIATRICS ◽  
1962 ◽  
Vol 29 (4) ◽  
pp. 527-538
Author(s):  
Elia M. Ayoub ◽  
Lewis W. Wannamaker
Keyword(s):  
Rheumatic Fever ◽  
Acute Rheumatic Fever ◽  
Streptococcal Infection ◽  
Acute Glomerulonephritis ◽  
Streptococcal Infections ◽  
Antibody Titers ◽  
Streptococcal Antigens ◽  
Anti Body ◽  
Antibody Tests ◽  
Normal Controls

Antibody titers for two recently described streptococcal antigens, desoxyribonuclease B (DNase B) and diphosphopyridine nucleotidase (DPNase) have been compared with antistreptolysin O (ASO) titers in patients with acute rheumatic fever, in patients with acute nephritis, and in normal controls. Like the ASO, elevated titers for the two new antibodies are commonly found in patients with complications of streptococcal infections. The titers for anti-DPNase tend to be higher in acute nephritis than in acute rheumatic fever. These two new anti-body tests are particularly useful in providing evidence of a preceding streptococcal infection in those patients with manifestations of acute rheumatic fever or acute nephritis who fail to show an elevated ASO titer.

THE EFFECT OF TONSILLECTOMY ON THE INCIDENCE OF STREPTOCOCCAL RESPIRATORY DISEASE AND ITS COMPLICATIONS

PEDIATRICS ◽  
1960 ◽  
Vol 26 (3) ◽  
pp. 355-367
Author(s):  
Robert Chamovitz ◽  
Charles H. Rammelkamp ◽  
Lewis W. Wannamaker ◽  
Floyd W. Denny
Keyword(s):  
Heart Disease ◽  
Respiratory Tract ◽  
Antibiotic Therapy ◽  
Rheumatic Fever ◽  
Acute Rheumatic Fever ◽  
Streptococcal Infection ◽  
Clinical Course ◽  
Respiratory Infections ◽  
Acute Illness ◽  
Streptococcal Infections

A population of military men with acute streptococcal respiratory infections (diagnosis established by clinical, bacteriologic and serologic studies) was investigated. Evidence is presented indicating that individuals who have had a tonsillectomy are neither more nor less susceptible to acute streptococcal infections of the respiratory tract. Once individuals acquire a streptococcal infection, the clinical course of the acute illness is not modified appreciably by the presence or absence of the tonsils. However, if antibiotic therapy is withheld, suppurative complications occur less frequently in those patients who have had their tonsils removed. Tonsillectomy did not alter significantly the attack rate of acute rheumatic fever as a sequel of streptococcal infections, nor did it reduce significantly the development of valvular heart disease in patients with acute rheumatic fever. Moreover, it appears that streptococcal infections are less readily recognized in tonsillectomized patients and, therefore, are more likely to escape treatment appropriate for the prevention of rheumatic fever.

EFFECT OF AUREOMYCIN TREATMENT OF STREPTOCOCCAL SORE THROAT ON THE STREPTOCOCCAL CARRIER STATE, THE IMMUNOLOGIC RESPONSE OF THE HOST, AND THE INCIDENCE OF ACUTE RHEUMATIC FEVER

PEDIATRICS ◽  
1953 ◽  
Vol 12 (6) ◽  
pp. 593-606
Author(s):  
HAROLD B. HOUSER ◽  
GEORGE C. ECKHARDT ◽  
EDWARD O. HAHN ◽  
FLOYD W. DENNY ◽  
LEWIS W. WANNAMAKER ◽  
...  
Keyword(s):  
Rheumatic Fever ◽  
Acute Rheumatic Fever ◽  
Streptococcal Infection ◽  
Treated Group ◽  
Carrier State ◽  
Control Group ◽  
Streptococcal Infections ◽  
Drug Of Choice ◽  
Penicillin Therapy ◽  
Treatment Data

A total of 1,009 patients with exudative tonsillitis or pharyngitis, predominantly streptococcal in etiology, was treated with aureomycin hydrochloride. A control group of 1,035 patients received no aureomycin. An illness classified as definite or possible rheumatic fever subsequently developed in 20 patients who had received aureomycin and in 29 who had received no treatment. Data collected on rheumatic subjects indicated that when the interval between the onset of the observed attack of exudative tonsillitis or pharyngitis and the onset of rheumatic fever exceeded 35 days, an intervening streptococcal infection had occurred. Five patients in the treated group and 20 in the control group developed rheumatic fever within a 35 day interval. These data indicated that aureomycin therapy greatly reduces the subsequent occurrence of rheumatic fever. Aureomycin therapy was also found to eradicate the streptococcus from the oropharynx in a large number of instances and to inhibit the formation of antistreptolysin. The degree of inhibition of antistreptolysin formation was shown to correlate with the eradication of the streptococci from the oropharynx. When bacteriologic relapse occurred following cessation of aureomycin therapy, the degree of inhibition of antistreptolysin production was low. Aureomycin therapy of streptococcal infections was compared to penicillin therapy of such infections. It was shown that penicillin was more effective in eradicating streptococci, decreasing antistreptolysin formation, and preventing rheumatic fever. Penicillin, therefore, is the drug of choice.

Group A Streptococcal Carriers

1981 ◽  
Vol 3 (2) ◽  
pp. 40-66
Keyword(s):  
Antibody Response ◽  
Rheumatic Fever ◽  
Failure Rate ◽  
Streptococcal Infection ◽  
Streptococcal Infections ◽  
Group A ◽  
Bona Fide

During an outbreak of streptococcal infection in an isolated community, 19% of individuals who had been treated appropriately failed to have their streptococcus eradicated. Retreatment was even less effective (40% failure rate). Antibody increases were not detected in treatment failures. The treatment failures were probably carriers. It is more difficult to eradicate organisms from carriers "..... perhaps because the organisms harboured by the carrier are multiplying less actively and hence are not as readily killed by penicillin." Bona fide asymptomatic streptococcal infections occur and must be separated from carriers. The latter (true carriers) have no antibody response. The carrier is unlikely to spread the organism or develop rheumatic fever.

scholarly journals FRI0445 HLA-B27 IN POSTSTREPTOCOCCAL REACTIVE ARTHRITIS WITH ENTHESITIS

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 820.1-820
Author(s):  
I. Naishtetik ◽  
L. Khimion ◽  
O. Yashchenko ◽  
P. Dolinskiy
Keyword(s):  
Rheumatic Fever ◽  
Reactive Arthritis ◽  
Streptococcal Infection ◽  
Joint Involvement ◽  
Hla B27 ◽  
Aseptic Inflammation ◽  
Beta Hemolytic Streptococcus ◽  
Common Diagnosis ◽  
Poststreptococcal Reactive Arthritis ◽  
Rheumatology Practice

Background:Poststreptococcal reactive arthritis (PSRA) is a very common diagnosis in rheumatology practice, which develops after recent pharyngeal streptococcal infection and characterized by aseptic inflammation in one or more joints and periarticular involvement. Now no diagnostic criteria have been agreed [2,4]; association of the expression of HLA-B27 and PSRA is not clear [1,3].Objectives:In our study we analyzed the features of PSRA in presence of HLA-B27.Methods:88 patients (48 female and 40 male) aged between 18-55 years with complains of pain, tender and swollen joints developed after recent pharyngeal streptococcal infection underwent standard physical and laboratory rheumatological examinations. Acute rheumatic fever and other inflammatory arthritis were excluded.Results:60 patients (68,2%) had oligo-polyarthralgia, 10 patients (11,4%) - monoarthritis, 24 patients (27,3%) had asymmetrical olygoarthritis, 4 patients (4,5%) had polyarthritis, enthesitis was found in 4 (4,5%) patients, tenosynovitis of the palmar flexor tendons in 10 cases (11,4%) and the peroneal tendons of the ankles in 5 patients (5,7%), one-sided sacroiliitis (confirmed by MRI) in 5 patients (5,7%).The mean level of ASL-O was 542 U/ml, CRP -15 mg/L, ESR - 34 mm/H; HLA-B27 was present in 24 (30,7%) patients. HLA-B27 positivity was connected to enthesitis, sacroiliitis, more joint involvement with higher levels of ESR and CRP.Conclusion:30% of patients with poststreptococcal reactive arthritis are HLA-B27 positive, the presence of HLA-B27 leads to more frequent development of enthesitis, polyarthritis and sacroiliitis with higher level of inflammatory activity which dictate the need for longer supervision of such patients for possible triggering of ankylosing spondylitis development.References:[1]Ahmed S, Ayoub EM, ScorniK JC, Wang C-Y, She J-X. Poststreptococcal reactive arthritis. Clinical characteristics and association with YLA-DR alleles. Arthritis Rheum 1998; 41:1096-102.9[[2]Gibofsky A, Khanna A, Suh E, et al. The genetics of rheumatic fever: Relationship to streptococcal infection and autoimmune disease. J Rheumatol Suppl. 1991;30:1–5. [PubMed] [Google Scholar][3]Leitch DN, Holland CD/ Reactive arthritis, beta-hemolytic Streptococcus and Staphylococcus aureus. Br J Rheumatol 1996;35:912.[4]Mackie SL, Keat A. Poststreptococcal reactive arthritis: what is it and how do we know? Rheumatology (Oxford) 2004;43:949–54. 10.1093/rheumatology/keh225 [PubMed].Disclosure of Interests:None declared

Sign in / Sign up

Export Citation Format

Share Document