ABSTRACT
The connection between rheumatic fever and a preceding streptococcal throat infection was first made a century ago. Because neither streptococci nor their degradation products could be found in the heart tissue of patients with rheumatic fever, it was realized that the disease, which follows about 2-4 weeks after a sore throat or scarlet fever, was a consequence of the immune response to the infection. The infection can be quite mild; in many instances patients have no recollection of a recent throat infection, but serological tests show that antibodies against group A streptococcal antigens are present. Rheumatic fever only follows a sore throat (pharyngitis) or scarlet fever caused by S. pyogenes, whereas other types of infections caused by S. pyogenes, such as those of the skin (impetigo) or the bloodstream do not lead to it.
