The Relationship of Throat Infection to Acute Rheumatism in Childhood

Schlesinger, Bernard

doi:10.1136/adc.5.30.411

Cited by 56 publications

(13 citation statements)

References 3 publications

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“…During two previous recrudescences, hemolytic streptococcus had been recovered from the throat flora. This organism was not found in the pharyngeal cultures from Dec., 1928, the date of sailing for Puerto Rico, until Feb. 14,1931. During this period of 26 months his rheumatic process appeared entirely quiescent.…”

Section: The Relationship Of Recrudescences In the Rheumatic Subject mentioning

confidence: 92%

Studies on the Relationship of Streptococcus Hemolyticus to the Rheumatic Process

Coburn

Pauli

1932

Journal of Experimental Medicine

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Certain factors of climate are favorable to streptococcus respiratory diseases. In those tropical environments where hemolytic streptococcus is unusual in the throat flora, scarlet fever is unknown and rheumatic fever rare. In New York City, however, following epidemic waves of pharyngitis with hemolytic streptococcus the incidence of rheumatic fever rises precipitously. The correlation between the geographical distribution of hemolytic streptococcus and rheumatic fever is a definite one. Furthermore, in New York City during the seasons of the year in which hemolytic streptococcus is seldom recovered from the pharynx, acute attacks of rheumatism are unusual. Corresponding to the seasonal rise in hemolytic streptococcus infections, the curve of incidence of acute rheumatism shows a similar form. Among the children of wealthy patients, enjoying great protection, hemolytic streptococcus has been recovered infrequently from the throat, and rheumatism has not been encountered during this study. Among the poor under observation in New York City, however, the organism is found frequently in the pharyngeal flora, and rheumatic fever is common. The findings suggest that poverty and unhygienic living conditions favor both the activity of hemolytic streptococcus in the throat and the incidence of rheumatic fever. Moreover, localized outbreaks of rheumatism have been observed frequently following epidemics of "sore throat". Bacteriological studies of these upper respiratory infections demonstrate a close relationship between the advent of hemolytic streptococcus in the throat flora and the outbreak of rheumatic fever in susceptible individuals. In addition to these studies of streptococcus infections and their relationship to the development of rheumatic fever, observations of the rheumatic patient add further emphasis to this association. First, among a group of rheumatic children in an isolated environment, reactivation of the rheumatic process has been recognized only following the advent of hemolytic streptococcus in the throat flora. Also, an investigation of families in which several members have rheumatic heart disease has led to the same conclusion. Recrudescences of the disease have been observed under a variety of conditions among these individuals. However, the one constant factor in the outbreaks of recrudescences in rheumatic homes is their association with family epidemics of hemolytic streptococcus infection. Moreover, by studying rheumatic patients before, during and after transplantation to a tropical environment, it has been possible to demonstrate a close relationship between activity of the disease process and infection with hemolytic streptococcus. While the rheumatic patients remained in the tropics this organism was not recovered from the pharyngeal flora, and the disease process seemed quiescent. On return to New York City, those individuals who have escaped respiratory infection have remained symptom-free. However, of those who have contracted hemolytic streptococcus pharyngitis, each has developed a rheumatic attack within 3 weeks after infection. Finally, extensive bacteriological studies made in ambulatory rheumatic subjects over a period of 4 years have demonstrated that the individuals who escape respiratory disease remain free of rheumatic manifestations. On the other hand, the majority of rheumatic patients who contract hemolytic streptococcus pharyngitis experience shortly afterward a definite recrudescence of their disease. In conclusion, there is a close relationship between respiratory infection with hemolytic streptococcus and activity of the rheumatic process in susceptible individuals.

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Section: The Relationship Of Recrudescences In the Rheumatic Subject mentioning

confidence: 92%

Studies on the Relationship of Streptococcus Hemolyticus to the Rheumatic Process

Coburn

Pauli

1932

Journal of Experimental Medicine

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“…Within recent years, beta haemolytic strains have gained increasing recognition in the reports of Glover (1930), Coburn (1931), Glover and Griffith (1931), Collis (1931), and 8 HAEMOLYTIC STREPTOCOCCAL INFECTIONS Bradley (1932). Similar investigations, such as that described by Schlesinger (1930), have led to the view that no single type of organism could be recognised as responsible for all infections, but that many species were involved. It may be noted that, in the majority of investigations in which beta hsemolytic streptococci have appeared important, the type of nasopharyngeal infection has been of the epidemic variety in enclosed populations such as those of schools, hospitals and training quarters.…”

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confidence: 55%

“…Perhaps a more striking demonstration of the connexion between the two conditions is supplied by the occurrence of outbreaks of rheumatism, mainly of rec'urrent attacks but sometimes primary, after epidemic tonsillitis. Many examples of this sequence are described in the literature by Raven (1923), Boas and Schwartz (1926), Hiller and Graef (1927-8), Glover (1930), Schlesinger (1930), Glover and Griffith (1931), Collis (1931), Sheldon (1931), Bradley (1932), and Coburn and Pauli (1935b).…”

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confidence: 96%

Haemolytic Streptococcal Infections and Acute Rheumatism

Green¹

1942

Annals of the Rheumatic Diseases

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“…Evidence to support this concept has been based on the close epidemiologic and bacteriologic association of acute rheumatic fever and streptococcal infection (1)(2)(3)(4)(5)(6)(7)(8)(9) as well as on the striking similarity of the antibody responses in both of these conditions (10). Despite this dependence of the rheumatic state upon prior hemolytic streptococcal infection, only a small portion of those exposed to this group of organisms actually develop rheumatic fever.…”

mentioning

confidence: 99%