RESUMO
In this article we discuss the epidemiologic changes in rheumatic fever leading up to the recent resurgence. The multifocal outbreaks occurred within the same time period, 1984 to 1988, in different sections of the United States and in Italy and Chile. The clinical manifestations in the current outbreaks were strikingly different than in the recent past--carditis was frequently present and very severe. One of the most unsual demographic features was that the majority of the patients lived in suburban or rural communities and were mostly white and middle class. However the average size of the families in which the index cases occurred was higher than in the corresponding populations, pointing out to the importance of crowding for spreading of streptococcal infectious and rheumatic fever occurrence. Still another contrast to prior outbreaks was that the recent ones did not follow clinically apparent epidemics of streptococcal infections. It is clear from the resurgence of acute rheumatic fever in the mid--1980s in developed countries among people with good living conditions, that rheumatic fever is worldwide problem. Intesified efforts to understand the pathogenesis of rheumatic fever should undertaken, but in the meantime, the preventive methods that are available should be vigorously applied.