THE PREVENTION OF STREPTOCOCCAL UPPER RESPIRATORY INFECTIONS AND RHEUMATIC RECURRENCES IN RHEUMATIC CHILDREN BY THE PROPHYLACTIC USE OF SULFANILAMIDE 1

Abstract

The effect on the incidence1 of rheumatic relapses in preventing streptoeoccal upper respiratory infections by the prophylactic use of sulfanilamide is reported. Small daily doses of the drug were given to half of a group of rheumatic children under close observation in a sanatorium from Oct. until June, during 2 successive winters. The1 contrast between the incidence of streptococcal upper respiratory infections and rheumatic relapses in the treated and untreated groups was clear-cut. Of the 108 children receiving sulfanilamide, only 2 children contracted streptococcal upper respiratory infections, and only one of these 2 patients showed signs of rheumatic activity. Among the 104 children who served as controls. 48 contracted st.reptococcal pharyngitis, and 23 of these, or 48%, developed definite rheumatic relapses, and 5 additional children had laboratory evidence1 or mild symptoms suggesting rheumatic activity. In accord with our previous experience, no rheumatic; relapses were observed in children who escaped streptococcal upper respiratory infections. Toxic manifestations developed in 15% of the children. Xo serious reactions were encountered. Children who did not develop toxic manifestations within 5 weeks tolerated the drug well. Evidence that rheumatic; relapses usually follow in the wake of upper respiratory infections associated with Group A hemolytic streptococci has been accumulating for many years. With the advent of sulfanilamide a specific means of preventing streptococcal upper respiratory infections in rheumatic subjects became available. In our series the incidence of streptococcal upper respiratory infections among the children in the control group was high and nearly 50% of those so infected developed rheumatic sequelae. Our findings, in accord with those of other workers, show that prophylactic doses of sulfanilamide are effective in preventing both -streptococcal upper respiratory infections and rheumatic relapses. Furthermore, these studies indicate that the relationship between streptococcal pharyngitis and the reactivation of the rheumatic process is specific and therefore establish the importance of Group A hemolytic streptococci as a factor in the etiology of rheumatic fever.