The relationship between acute rheumatism and streptococcal antifibrinolysin

Abstract

That haemolytic streptococci of human origin produce a substance capable of liquefying human fibrin was first demonstrated by Tillet and Garner in 1933. The fibrin from patients recently recovered from haemolytic streptococcal infection was in many cases found to be resistant to the action of this fibrinolysin.Further work (Tillett, Edwards and Garner, 1934 ;Tillet, 1935) Tillett found that in some cases it was present at the time of recovery, but that in others its appearance was delayed for two to four weeks after the acute infection. There was a suggestion that it developed earlier in cases of erysipelas than in those with an acute streptococcal pharyngitis. These observations were confirmed by Myers, Keefer and Holmes (1935), who also showed that the resistance of the plasma to fibrinolysin, once developed, persisted for a varying time, and Spink and Keefer (1936) found that in erysipelas antifibrinolysin can be demonstrated from eight to a hundred and fifty days after the attack. Waaler (1936) found that patients with scarlatina did not all develop antifibrinolysin, and that in those who did, it might first appear from one to five weeks after the infection, similar observations being made by Stuart-Harris (1935, a and b). From this work it is now clear that it is rare for antifibrinolysin to be present in the blood unless the patient has comparatively recently experienced a streptococcal infection. The occasional cases to the contrary can be explained by assuming that the antifibrinolysin has persisted long after the infection to which it is due has been forgotten. Antifibrinolysin ranks with antistreptolysin as one of the antibodies produced as part of the immunity mechanism following infections with haemolytic streptococci. The presence of these antibodies in the blood does not necessarily run parallel, and Stuart- Harris (1935b) has shown that there is no correlation between antistreptolysin and antifibrinolysin except that when the fibrin is completely resistant to fibrinolysin there is usually some rise in the antistreptolysin titre.Shortly after Tillett and Garner's original reports, Hadfield, Magee and Perry (1934) found that the fibrin of many patients in the active stage of acute rheumatism was partially or completely resistant to fibrinolysin. This was regarded as further evidence of the frequent occurrence of a haemolytic 32 on 13 May 2018 by guest. Protected by copyright.

The Streptococcal Antifibrinolysin Test in Clinical Use 1

“…The presence of positive tests in rheumatic fever, chorea, and nephritis is in accord with the findings reported in the literature (3,4,5,6,12,15,16,17,18). Six of our patients with rheumatic fever were retested 3 to 5 months after discharge from the hospital and all continued to show strongly positive tests although they had apparently been free from any significant infections.…”

The Effect of Salicylates on the Precipitation of Antigen With Antibody

“…Furthermore, when administered to the rheumatic subject during hemolytic streptococcal respiratory infection and the symptom-free interval following, they prevent the development of a rheumatic attack or suppress it below the clinical level (8). That this may be associated with an effect on antibody is suggested by the observations of Perry (9).…”

Streptococcal Antifibrinolysin in Rheumatoid Arthritis and Spondylitis Ankylopoietica

“…of forty-four patients (Perry, 1939); and they show that streptococcal antifibrinolysin is not found at all commonly in the blood of patients suffering from rheumatoid arthritis or spondylitis ankylopoietica.…”

“…Repeated observations were made during and after treatment with gold salts, and in all 171 observations were made on the thirty-three patients, only eight patients being tested once only. The technique was similar to that described by Tillett and Garner (1933), and every plasma was tested against four different strains of streptococci, as described by Perry (1939). Of the 171 observations, 161 fell within the normal range.…”