RESUMEN
Acute rheumatic fever remains a common disease in Jamaica. Between August, 1973 and July, 1978, there was only one death recorded among children under 12 years admitted to the University Hospital of the West Indies with this disease. There were 38 - 48 annual admissions for the disease during this period. Between August, 1978 and July 1979, there were 26 admissions for rheumatic fever. Five of these children presented with an unusually severe form of acute rheumatic fever which led to a fatal outcome in four cases. Only one of these children had previous admissions for the disease and he had received no penicillin prophylaxis for the preceding four months. The only surviving child developed frank pulmonary oedema within a few hours of admission and required ventilation for 5 days. Post-mortem findings in 4 cases showed rheumatic pancarditis, oedema and congestion of the lung and congestion of the liver. Decline in the incidence and severity of acute rheumatic fever has been reported from several centres since the 1920s. These recent cases of severe acute rheumatic fever may represent an incidental clustering of cases or may indicate that the severity of the disease is increasing in this population (AU)