Abstract
When streptococcal infections with an antistreptolysin O response occur in spite of prophylaxis with penicillin administered orally, throat cultures are often falsely negative. In comparisons of rheumatic children given prophylaxis with siblings not receiving prophylaxis, cultures were negative in only 4.1% of 244 clinical infections in siblings but in 34.4% of 61 clinical infections in rheumatic children. Corresponding figures for subclinical infections were 12.8% of 384 infections in siblings and 49.5% of 95 infections in children receiving prophylaxis. Masked streptococcal infections are dangerous. Thus, 15 rheumatic fever recurrences followed 68 such infections, whereas six recurrences occurred in 88 infections with positive cultures. Although penicillin often masked throat cultures when streptococcal infection occurred in spite of prophylaxis, it did not alter the frequency with which streptococcal infections caused clinical symptoms.
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