A 45-YEAR PERSPECTIVE ON THE STREPTOCOCCUS AND RHEUMATIC-FEVER - THE EDWARD-H-KASS-LECTURE IN INFECTIOUS-DISEASE HISTORY

Rheumatic fever has been considered a major problem among civilians in the United States and elsewhere for 100 years but was not recognized as a concern among the U.S. military until World War II. At that time the only available control measure was antimicrobial prophylaxis of re current rheumatic fever. Subsequent studies, conducted primarily by th e Streptococcal Diseases Laboratory of the Armed Forces Epidemiologica l Board, demonstrated that rheumatic fever could be prevented by the t reatment of patients with streptococcal pharyngitis and by the adminis tration of penicillin for the prophylaxis of streptococcal infections in large groups. With the use of available preventive measures, rheuma tic fever virtually disappeared by the 1970s. In 1985, however, rheuma tic fever and severe streptococcal infections reappeared, first in the Rocky Mountain area. It is speculated that this reappearance was due to special strains of group A streptococci and-in severe cases-the pro duction of pyrogenic exotoxins. At present, cases continue to occur bu t not at the level seen in the late 1980s.