| Popis: |
The view that the rheumatic process is initiated or activated by streptococcal respiratory infections has met with wide acceptance. The evidence which has accumulated in support of this conception originated in the long recognized association of tonsillitis and rheumatic fever, as well as the so-called rheumatic sequelae of scarlet fever. The more recent observations of Glover (1), Schlesinger (2), Coburn (3), Collis (4) and others have stressed a broader view of streptococcad respiratory infections and have included such infections as pharyngitis, common cold, sinusitis, otitis, bronchitis and cervical adenitis. It is important to note that the presence of hemolytic streptococci in the flora of the throat during these infections has been considered by many observers as diagnostic of a streptococcal respiratory infection, the criteria for diagnosis being bacteriologic rather than clinical. Coburn and Pauli (5) from extensive epidemiological, bacteriological and immunological studies postulate that the hemolytic streptococcus initiates the rheumatic process. The majority of investigators emphasize the quiescent period (of apparent health), a period of approximately seven to twenty-one days between the respiratory infection and the subsequent rheumatic recurrence, lending support to the hypothesis that rheumatic fever is allergic in nature. Paul and Salinger (6) from historical family studies have described simultaneous waves of respiratory infections and rheumatic recrudescences in several members of the household. Similar observations have been reported by various investigators, occurring in schools, camps, hospital wards and convalescent homes. In some instances |
