Paul L. Boisvert

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.

The clinical behavior of the hemagglutination test for rheumatoid arthritis

Abstract In summary several points stand out. 1.1. The fact that the hemagglutination test is positive in a much smaller percentage of individuals with rheumatoid spondylitis, juvenile rheumatoid arthritis and rheumatoid arthritis with psoriasis remains unexplained. 2.2. In our hands the titer of the test seems to show distinct changes only in patients (thirteen of fifteen) with dramatic Grade 1 clinical remissions. The test even became negative in ten of the thirteen individuals with such dramatic changes. 3.3. Among the controls the test was positive chiefly in those with related collagen disease or in individuals whose diagnosis was not determined. 4.4. The sensitivity of the test in early atypical cases has not yet been proved, chiefly because of the lack of diagnostic criteria. Its sensitivity in typical early or advanced peripheral rheumatoid arthritis is clearly shown, even among individuals with a illness of less than six months.

The treatment of rheumatic fever with penicillin

Summary 1. The administration of penicillin did not favorably affect the course of rheumatic fever in six individuals. 2. Group A hemolytic streptococci were eliminated from the nasopharynx in every case.

Selectivity of heparin-latex method and sensitized sheep cell test for rheumatoid serums.

Summary Results of an agglutination test using polystyrene particles sensitized with 0.5% heparin are described. Sensitivity and selectivity of this system for rheumatoid serums compares favorably with those of the standard sensitized sheep cell test method. A high proportion of rheumatoid serums was found to give positive reactions with non-sensitized latex particles.

Qualitative Differences between Positive Streptococcal Antifibrinolysin Tests.

Positive streptococcal antifibrinolysin tests 1 2 3 are generally regarded as indicative of the presence of a specific “antibody.” There are instances, however, when this seems unlikely. 4 Milstone5 has recently demonstrated that the plasma-clots of rabbits are resistant to lysis by human strains of hemolytic streptococci because they lack a substance—“lytic factor”—which is present in normal human serum. The addition of “lytic factor” to rabbit plasma results in rapid liquefaction of the clot by fibrinolysin. This observation was of considerable interest to us because of its possible clinical application since it might explain some of the apparently non-specific positive antifibrinolysin tests (resistant clots) which we have observed in infants and children. 4 Newborn blood frequently gives a positive test in spite of the fact that there is no clinical or bacteriological evidence of a recent hemolytic streptococcal infection in the mother and her test is negative. 6 , 4 As a starting point for the present study the blood from newborn infants was chosen first for comparison with the blood of children with positive tests following a hemolytic streptococcal infection. It seemed likely that newborns would generally have resistant plasma-clots for only one of two reasons—either because of absence of a substance or because of the presence of antifibrinolysin. In sick children both of these factors might be involved. This study represents a comparison of the blood of 10 normal newborns with that of 10 children who were convalescing from scarlet fever and other hemolytic streptococcal infections. All had maximally positive streptococcal antifibrinolysin tests. Methods The routine antifibrinolysin tests was performed as originally described by Tillett and Garner. 0.2 cc of human plasma was diluted with 0.8 cc of normal salt solution. To this was added 0.5 cc of an 18-hour broth culture of hemolytic streptococcus (known to dissolve normal plasma-clots in 15 minutes).

PROCEEDINGS OF AMERICAN RHEUMATISM ASSOCIATION, ATLANTIC CITY, JUNE 8, 1942: ABSTRACTS AND DISCUSSIONS OF PAPERS: EPIDEMIC RHEUMATIC FEVER

Excerpt Epidemic rheumatic fever is not a new disease but it does have especial importance in times, such as these, when large numbers of men are concentrated in military cantonments. The term, epi...