[Bouillaud's disease in Martinique. Epidemiological and nosological features]

From the epidemiological point of view there does not appear to be any particular geographical pattern of this disease. Indeed, it is poor living conditions, low family income, large family size and poor oro-dental hygiene which are responsable for the outbreak of small familial epidemics of acute rheumatic disease of the joints; from the clinical point of view, acute rheumatic joint disease presents no particular features in the Antilles. All the characteristics described in the classical works are found, including the malignant form, whose rarity is emphasised. A programme of prevention of rheumatic disease has yet to be started in the Antilles, and we feel that it should be a three-pronged attack: 1. More information to the general public on the necessity for rapid treatment of the symptoms; 2. Increased vigilance by the medical services in the fight against this disease of deprivation, and close collaboration with the social services; 3. Finally, the setting up of a specialised social cardiology service to supervise the young rheumatic patients, and to ensure that they are educated. Such arrangements would avoid the disorganisation sometimes experienced by the families and friends; it must be admitted that we sometimes have to prevail upon the family to allow the child to be transferred to a centre of social cardiology on the continent so that the young rheumatic patient may receive training for a career which is compatible with his or her handicap.

Penicillin V therapy for streptococcal pharyngitis: comparison of dosage schedules

Two dosage regimens of penicillin V were compared in 327 patients with mild to moderately severe streptococcal pharyngitis. Patients fulfilling study criteria were randomly assigned to a b.i.d. or a t.i.d. dosage schedule. Those in the b.i.d. group were given 500 mg twice daily; those in the t.i.d. group were given 250 mg three times daily. Duration of therapy was ten days for both groups. Cure was based on prompt symptomatic improvement, subsidence of clinical signs, and negative throat cultures for group A beta-hemolytic streptococci. Both dosage schedules yielded similar cure rates, indicating that with penicillin V, a b.i.d. regimen is as effective as a t.i.d. regimen in treating streptococcal pharyngitis.

Group A streptococcal infections as related to rheumatic fever

Beta-hemolytic streptococci were recovered frequently, particularly from the throats of children, and the same type of group A strains was isolated from both throats and tonsils. A significant antibody response to streptolysin O was observed in 44.8 to 43.5 % of the children whom group A streptococci were recovered. It is considered that these children had the definite evidence of acute streptococcal infections, and administration of josamycin, penicillin G, and benzyl penicillin V benzathine decreases the frequency of recovery of beta-hemolytic streptococci and prevents rheumatic fever.

Histopathological and histochemical studies on the tonsils in children with rheumatic heart disease

The tonsils were studied histologically and histochemically in 67 children with rheumatic heart disease, 33 children with chronic tonsillitis and 5 normal children. The tonsils of rheumatic children showed hyperplasia and hyperactivity of lymphocytes and paucity of phagocytes. It was suggested that these peculiar findings might contribute to the pathogenesis of rheumatic fever.

Acute rheumatic fever following streptococcal wound infection

A case of acute rheumatic fever with pancarditis secondary to infection of abrasions on the hand with β-haemolytic streptococci is described.

[Tonsils and immunology (author's transl)]

Tonsils are lymphatic organs carrying out functions of humoral and cellular immunity. They form a local immunologic barrier; they are also involved in general immunologic defence mechanisms. Tonsillectomy or the destruction of tonsils by infections does not reduce the immunoglobulin concentration and antibody titres in peripheral blood. Only the local formation of IgA antibodies against poliomyelitis antigen seems to be impaired at least for a short time. The clinical relevance of this finding is unknown. Signs of defects in immunosurveillance, which were found in some study groups resulting from an increase of the morbidity rates of Hodgkin's disease and thyroid carcinoma, must be considered seriously although there is no statistic evidence for an increase of tumor frequency after tonsillectomy. The indication for tonsillectomy must be decided on clinical findings. Signs for a reduction of local antibody synthesis or for a possible diminuation of immunosurveillance should serve to critical indication.

HL-A antigens in Europeans and Maoris with rheumatic fever and rheumatic heart disease

Using a standard microtoxicity technique of tissue typing, the distribution of tissue antigens in 75 Maoris and 514 European disease-free blood donors was determined. Fifty Maori and 50 Europeans with rheumatic fever or rheumatic heart disease were compared with each control group. Normal Maoris had HL-A3 less frequently than Europeans (P less than .0005). HL-A28 was reduced (P less than .005) and HL-A17 increased in European patients (P less than .0005). In Maori patients there were minor differences in the frequency of HL-A3 and 8, which were increased, and HL-A10, which was diminished.

Prevention of streptococcal sequelae by penicillin prophylaxis: a reassessment

In conclusion, the diagnosis of streptococcal infection lacks precision, and as long as this is so, reliance must be placed on trained clinical judgement together with bacteriological studies. There is some evidence for an evolutionary drift in the relationship between the streptococcus and man, a drift that is compatible with the natural history of other diseases and with the accomodations observed in nature among other species during the course of evolutionary events. If, as a result of recent accomodations between man and the group A streptococcus, the risk of rheumatic fever is less, an undefinable risk nevertheless remains. There was even a military outbreak of rheumatic fever in England several years ago, and on that island--we are told--rheumatic fever has been banned for years. The current recommendations of the American Heart Association for the secondary prevention of rheumatic fever I judge acceptable for use in the United States. I have, however, raised the possibility that they may be inadequate for the prevention of second attacks in other populations where the environmental, socioeconomic, bacteriological, and nutritional circumstances are different from our own. Studies designed to reexamine these questions may, in the end, refocus our attention on the importance of host factors in the occurrence and pathogenesis of rheumatic fever.

Cellular reactivity studies to streptococcal antigens. Migration inhibition studies in patients with streptococcal infections and rheumatic fever

The question of whether hypersensitivity to streptococcal antigens plays a role in the pathogenesis of the nonsuppurative sequelae of streptococcal infections remains at present unclear. As a first step in the approach to this question, the degree of cellular reactivity of peripheral blood leucocytes to streptococcal antigens was investigated in a number of rheumatic fever patients, patients with uncomplicated streptococcal infections, as well as normal healthy subjects. Using the in vitro technique for the inhibition of capillary migration of peripheral blood leucocytes as an index of the degree of sensitivity to streptococcal antigens, the results indicate that patients with acute rheumatic fever exhibit an exaggerated cellular reactivity to these antigens and in particular to streptococcal cell membrane antigens. This abnormal response to streptococcal membrane antigens appears to persist in rheumatic subjects for at least 5 yr after the initial attack of rheumatic fever. Only Group A streptococcal membrane antigens elicited this unusual response in rheumatic subjects, since the cellular reactivity to Group C and D streptococcal membranes was the same in all groups. Patients with evidence of valvular disease exhibited the same degree of cellular reactivity to these antigens as did patients without clinical evidence of rheumatic heart disease. The nature of the antigens responsible for the observed cellular response remains unknown. Enzymatic treatment of streptococcal cell walls and membranes designed to remove type-specific M proteins did not alter the observed cellular reactivity to the streptococcal antigens. The finding that an abnormal cellular response to certain streptococcal antigens is present only in rheumatic patients suggests that cell-mediated factors may play an important role in the disease process.