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Variation in Group A Streptococci and the Prevalence of Rheumatic Fever: A Half-Century Vigil

Gene H. Stollerman, MD
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Boston University School of Medicine, Edith N. Rogers VA Medical Center, Bedford, MA 01730. Requests for Reprints: Gene H. Stollerman, MD, Edith N. Rogers Memorial Veterans Hospital, 200 Spring Road, Bedford, MA 01730.

Copyright ©2004 by the American College of Physicians

Ann Intern Med. 1993;118(6):467-469. doi:10.7326/0003-4819-118-6-199303150-00012
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This editorial reviews a current report of the disappearance of recurrent rheumatic fever in a Chilean cohort followed prospectively in which antibiotic prophylaxis was discontinued, although sporadic outbreaks of rheumatic fever continued to be observed in neighboring communities with similar racial, ethnic, and socioeconomic characteristics. Observations of the past 50 years are cited to support an explanation that changes in the attack rate of rheumatic fever can be explained not only by the relative frequency of group A streptococcal infections and their appropriate treatment but, in addition, by quantitative and qualitative differences in strain virulence properties that determine whether group A streptococci are rheumatogenic.

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