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In a message dated 98-09-18 13:30:24 EDT, you write:
 
<< What is the risk of developing ARF in untreated pharyngitis?  >>
 
Generally, when GABHS is the cause of cardiovascular (endocarditis,
myocarditis, pericarditis), musculoskeletal, or lymphatic/phlebitis
infections, illness progresses rapidly and is marked by high fever and
systemic toxicity.
The major objective of antibiotic therapy is to prevent rheumatic fever and
possibly reduce the incidence of poststreptococcal glomerulonephritis.  About
8% to 40% (can approach 60-70%) of children and 5% to 9% of adolescents who
have a sore throat, fever and tonsillopharyngeal inflammation HAVE GABHS
infection.
The treatment of GABHS infections should relieve the symptoms of the acute
illness, eliminate transmissibility, and prevent both suppurative and
nonsuppurative sequelae.
It is not the spontaneous resolution of illness symptoms, but the persistence
of GABHS in the tonsillopharynx that sets the stage for ongoing contagion and
the risk for acute rheumatic fever.  The transmission rate of GABHS is 35%
within a family or school if the patient is untreated!  The efficacy of
penicillin for the primary prevention of acute rheumatic fever was established
in the early 1950's.  Development of streptococcal toxic shock syndrome and
necrotizing fasciitis (flesh-eating bacteria) are rising concerns.  There has
been a steady and dramatic decline in the incidence of acute rheumatic fever
probably due to improving socioeconomic conditions, better access to medical
care and a shift from rheumatogenic to nonrheumatogenic strains.
On the side, I have read that George Washington died from GABHS infection.
Andrew MD
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