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January 12, 1976

Rheumatic Fever in Warm Climates

Author Affiliations

School of Medicine San Juan, PR

JAMA. 1976;235(2):143. doi:10.1001/jama.1976.03260280011002

To the Editor.—  In reading the article of Barnert et al (232:925, 1975), I was surprised by the first sentence: "Acute rheumatic fever (ARF) is considered a disease of decreasing incidence, less common in warm climates, and rare in adults.11The following four references amply confirm that the above statement is incorrect:

  1. Suárez R: Incidence of heart disease in Puerto Rico. Am Heart J 29:339, 1945.

  2. Francisco R: Rheumatic heart disease in the tropics with special reference to its incidence in Puerto Rico. Clinics 5:971, 1946.

  3. Garcia-Palmieri MR, Costas R Jr, Diaz-Rivera RS: Rheumatic fever in the tropics. Am Heart J 63:18, 1962.

  4. Garcia-Palmieri MR: Rheumatic fever and rheumatic heart disease as seen in the tropics. Am Heart J 64:577, 1962.

In the fourth reference, 44 references are cited to add strength to our claim; multiple articles confirming our claim have been published since 1962.