Rheumatic Recurrences in Patients Not Receiving Continuous Prophylaxis

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Abstract
Continuous antistreptococcal prophylaxis was not administered to 358 rheumatic fever patients after five or more years had elapsed since their last attack. Streptococcal infections which occurred during the subsequent five years were treated if they were symptomatic. Of 193 immunologically-proved infections observed, 78% were asymptomatic and therefore were untreated. Such infections and rheumatic recurrences were approximately twice as frequent in adolescents as in adults. The rate of recurrence following 100 untreated asymptomatic streptococcal infections was 5.3 in adolescents and 4.8 in adults. Recurrence rates increased to 11.7 following infections which provoked vigorous antistreptolysin O responses. Such rates, however, were considerably less than those reported for comparable infections in rheumatic children.