IT IS KNOWN that acute rheumatic fever can occur in tropical environments,1-4 although it was believed to be rare or absent in some tropical areas.5-6 On the other hand, it has not been established how much rheumatic fever exists in tropical areas, and it is uncertain whether the disease presents the same clinical picture observed in temperate zones.
It has been stated by some that the clinical expression of rheumatic fever is milder in tropical climates than in temperate regions.7 Others believe that rheumatic heart disease is found in the tropics but that acute rheumatic fever is rarely seen.2 Moreover, it was pointed out in 1931 that children with active rheumatic disease transported from New York to San Juan escaped hemolytic streptococcal infections in Puerto Rico and benefited temporarily, even though they developed recurrences on returning to New York.6 More recently, some investigators have concluded
SHEFFERMAN MM, GOODMAN JS, ULTAN LB, VALDES J. Acute Rheumatic Fever in Puerto Rico. Am J Dis Child. 1965;110(3):239–242. doi:10.1001/archpedi.1965.02090030253003
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