IN THE natural history of rheumatic fever, there are two sets of observations, the epidemiologic1 and the immunologic,2 which bear some implication as to a specific etiologic agent. The data in both these fields of observation point to the hemolytic streptococcus as having some causal relation to the disease, although they offer no hint of a possible mechanism by which the hemolytic streptococcus might cause the phenomena of rheumatic fever. In the immunologic field, earlier analytic work on this question, as well as current work in these laboratories,3 has been reviewed elsewhere.
Among the biochemical effects which might be caused by the streptococcus, the possible role of streptococcic hyaluronidase in the pathogenesis of rheumatic fever has been the subject of recent speculation.4 This speculation has been based on three propositions: ( 1) Rheumatic fever is a disease of hyaline connective tissue; (2) hyaluronic acid, which characterizes hyalin,
HARRIS TN, FRIEDMAN S. RELATION OF THE HEMOLYTIC STREPTOCOCCUS TO RHEUMATIC FEVER: IV. Effect of Streptococcic Spreading Factor in Rheumatic Patients and Others. Am J Dis Child. 1949;77(5):561–575. doi:10.1001/archpedi.1949.02030040575001
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