Rheumatic fever and rheumatic heart disease

Abstract

Mortality rates for both rheumatic fever and rheumatic heart disease have dropped in the more highly developed countries. A few dissenting opinions on the usually accepted epidemiologic influences have been voiced but, in general, the well known epidemiologic characteristics of rheumatic fever, such as overcrowding and low socioeconomic background, have been confirmed. Ethnic differences, in general, are believed to be the result of differences in the socioeconomic distribution of the population. The search for the rheumatogenic strain of Streptococcus, or the rheumatogenic component of the streptococcus continues, but to date these strains or components have not been identified with certainty. In several surveys the correlation between the presence of the group A Streptococcus in the throats of children and concurrent respiratory infection was very low. Because the exact role of the hemolytic streptococcus in the pathogenesis of rheumatic fever has not been irrefutably demonstrated, the search for a virus as the etiologic agent is being carried on in Russia and other parts of the world, but to date no virus has been confirmed as an etiologic agent. Investigation of the presence of secretor status of ABO blood groups in saliva and rheumatic fever do not, in general, support the hypothesis that non secretor status is associated with susceptibility to rheumatic fever. The role of a cross reaction between group A Streptococcus and human heart tissue in the etiology of rheumatic fever is apparently indirect, and it is still uncertain that a cross reacting system involving heart smooth muscle could be associated with rheumatic manifestations other than myocarditis and arteritis. The relation to valvular disease, subcutaneous nodules, chorea, arthritis, and other rheumatic involvement is not apparent. Penicillin is the universal choice as the antibiotic preferred in the prevention of recurrences of rheumatic fever. Although penicillin prophylaxis is widely used throughout the world, rheumatic fever continues to recur.