SPECIAL ARTICLE

Abstract

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.