The families of patients with acute rheumatic fever or glomerulonephritis in Trinidad

ABSTRACT

The families of 21 patients with acute rheumatic fever (ARF) and 44 patients with acute glomerulonephritis (AGN) in Trinidad were examined in their homes. The ARF and AGN families were equally large and crowded and they lived in the same largely rural areas. However, only 22 percent of the ARF family members had skin infections in contrast to 61 percent of the AGN family members. Sixty-eight per cent of skin infections in ARF families and 69 percent of skin infection in AGN families yielded group A streptococci. Throat cultures were positive in 19 percent of ARF family members and 25 percent of AGN family members. Thirty-two per cent of 51 group A strains isolated from ARF family members (29 from throat, 22 from skin) were M11 of "M41" strains which were associated with ARF during the study, while only 8 percent were M1, T4 (MNT or 60) or M55 strains which were associated with AGN. In contrast, 49 percent of 171 group A strains isolated from AGN family members (64 from throat, 107 from skin) were M1, T4 (MNT or 60) of M55 while only 10 percent were M11 of "M41." Serum antibody titres were similar in both groups antistreptolysin-0 titres were not markedly increased in either while anti-hyaluronidase and/or antideoxyribonuclease-B titres were increased in both. Evidence of subclinical AGN was found equally often in both groups 6 percent of each had abnormal urine and 4 percent of each had decreased serum complement while 2 percent of the ARF and 3 percent of the AGN family members had both abnormal urine and decreased serum complement.(AU)