Grover F. Powers

Age as a factor in streptococcosis

Summary In summarizing this study of age as a factor in the natural history of infection with the hemolytic streptococcus of Group A, attention is first called (Table VIII) to the importance of recognizing the role (A) of the upper respiratory tract. Here the organisms have their primary habitat and natural portal of entry in the great majority of patients; they cause the disease designated streptococcal fever which expresses itself in different clinical patterns at different age periods. In some cases the microbes may be present without causing clinical evidences of disease. From the original site of localization the streptococci by blood stream dissemination, by contiguity or by implantation produce (B) lesions in skin, glands, viscera, meninges, bone, or sinuses. After a latent phase of varying length and by a mechanism probably akin to that of allergic reactivity, there sometimes develop sequelae (C) in the form of acute hemorrhagic nephritis and a polyarthritis similar to if not identical with rheumatic fever. To the various types of clinical response the designations childhood, intermediate, adult, and latent seem, after the manner in clinical tuberculosis, appropriate; undoubtedly there are mixed and transition forms in both diseases. In general, suppurative lesions are more frequently observed in the childhood type of streptococcal fever and the nonsuppurative sequelae after the intermediate and adult types. The intermediate type, scarlet fever, may be thought of as two diseases—the erythrogenic toxemia and streptococcal fever, either childhood type or adult type. This study furnishes the basis for an integrating concept of streptococcal infections and emphasizes the fact that they change in clinical pattern with age just as does body form and endocrine maturation in the complex process we call growth and development.