Clinicians have long recognized that an attack of acute rheumatic fever is preceded in many instances by sore throat or some other infection of the upper respiratory tract. This is true for both an initial attack of the disease and an exacerbation of symptoms. Williams,1 in discussing this subject, concluded that "the majority of all cases of rheumatic fever are preceded by sore throat or some upper respiratory infection." Observers of this relationship have further noted that the rheumatic symptoms do not immediately follow the respiratory infection, but that there is an interval of from ten to twenty-one days. Recently a number of careful investigators called attention to the presence of hemolytic streptococci in the throats of persons who later manifest the symptoms of acute rheumatic fever. They laid great emphasis on this point, believing that an etiologic relationship exists. An equally careful group of observers, however, believe that
WEINSTEIN I, STYRON NC. BACTERIOLOGIC STUDY OF THROATS IN RHEUMATIC AND NONRHEUMATIC FEVER: WITH SPECIAL REFERENCE TO HEMOLYTIC STREPTOCOCCI. Arch Intern Med (Chic). 1934;53(3):453–477. doi:10.1001/archinte.1934.00160090130011
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