The chain that links the heart to the throat

Abstract

One of the most peculiar, constant, and neglected facets of the pathogenesis of rheumatic fever is the necessity that the initiating infection take place in the upper respiratory tract. In this analysis, studies on streptococcal infections of the skin were used as a foil, exploring some of the local factors which might be significant determinants in the development of this complication. Critical examination of the accumulated data would suggest that the location of infection is equally as important as the infecting agent in the pathogenesis of rheumatic heart disease. For this reason, the site of infection deserves renewed attention by clinicians and investigators interested in rheumatic fever and its etiology.