Rheumatic Fever in Children and Adolescents: A Long-term Epidemiologic Study of Subsequent Prophylaxis, Streptococcal Infections, and Clinical Sequelae: IV. Relation of the Rheumatic Fever Recurrence Rate per Streptococcal Infection to the Titers of Streptococcal Antibodies

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.

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SPECIAL ARTICLE

PEDIATRICS ◽

10.1542/peds.15.5.642 ◽

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.

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

PEDIATRICS ◽

10.1542/peds.49.4.636 ◽

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.

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

Epidemiology and Infection ◽

10.1017/s002217240003672x ◽

1953 ◽

Vol 51 (4) ◽

pp. 450-457 ◽

Cited By ~ 21

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.

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