That there is a relationship between group A streptococci and rheumatic fever is now part of accepted medical knowledge, but the exact cause of rheumatic fever remains a mystery. Stollerman1 has summarized 2 popular current hypotheses: (a) "... rheumatic fever occurs most readily in a host who has been rendered hyperimmune to the group A streptococcus and... the attack rate of rheumatic fever bears some relationship to the intensity and/or frequency of streptococcal infection and to the virulence and epidemicity of the infecting streptococcal strains;... (b)... repeated streptococcal infections may not be necessary but... certain genetically predisposed hosts, representing a relatively small percentage of the general population, will develop rheumatic fever if they contract streptococcal pharyngitis due to strains of sufficient virulence to produce a strong antigenic stimulus or to persist in the host for a sufficient period of time."
A third hypothesis implies that:
BETA-HEMOLYTIC STREPTOCOCCI. JAMA. 1962;181(3):250–251. doi:10.1001/jama.1962.03050290072013
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