Epidemiology of acute rheumatic fever in South Trinidad - abstract

ABSTRACT

Streptococcal infections have been studied in South Trinidad during and for five years following a major epidemic of acute glomerulonephritiis (AGN). Many of these infections have been in the skin, especially in children in the rural areas. The relation of these infections to acute rheumatic fever (ARF) also has been examined with the following conclusions: During the mafor epidemic of AGN in 1964 and 1965, the incidence, of ARF decreased. This is in accordance with the current hypothesis that rheumatogenic streptococcal strains rarely are nephritgenic and vice versa. Since 1966, however, three increases in incidence of AGN have been accompanied by modest increases in the incidence of ARF. The streptococcal strains isolated from patients with ARF usually were not of the types concurrently isolated from patients with AGN. Moreover the lack of skin infections in the patients with ARF is striking in comparison with "normal" school children as well as with patients with AGN. Antristreptolysin O (ASO) titres in patients with ARF, as with AGN, increased only slightly or not at all while antithyaluroindase titres increased to similar high values in patients with both AGN and ARF. The lack of increased ASO titres in patients with ARF is in control to observations in other geographic areas where they consistently have been high. The lack of increased ASO titres in patients with AGN in Trinidad, as in other areas where AGN is associated with skin infections, has been attributed to the site of infections. However, no cases of ARF have been definitely related to skin infections in Trinidad or elsewhere (AU)