STUDIES ON THE IMMUNE RESPONSE OF THE RHEUMATIC SUBJECT AND ITS RELATIONSHIP TO ACTIVITY OF THE RHEUMATIC PROCESS. VI. THE SIGNIFICANCE OF THE RISE OF ANTISTREPTOLYSIN LEVEL IN THE DEVELOPMENT OF RHEUMATIC ACTIVITY 1

Abstract

The authors have observed that respiratory infection with a strain of hemolytic streptococcus producing strong toxin is not invariably followed by rheumatic recrudescence 2 in a susceptible sub- ject. This observation has been made under sev- eral different circumstances. (a) Two rheumatic children escaped rheumatic activity in spite of infection with a strain of hemolytic streptococcus that produced severe recrudescences in fourteen others living in the same home (1). ( b) In- fections with a scarlatinal strain of hemolytic streptococcus, occurring simultaneously in two rheumatic siblings were followed by rheumatic attacks, one of which was severe and prolonged, the other extremely mild (2). (c) Scarlet fever in one rheumatic subject under close observation was followed by only mild carditis. (d) Several of the strains described in the fourth paper of this series (2) produced strong toxin and streptolysin but were not effective in initiating recrudes- cences. The one characteristic common to all of these individuals who escaped attacks was the failure to develop a significant rise in antistreptolysin titer. The present paper deals with the significance of changes in antistreptolysin level in the rheu- matic subject.