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The factors that determine whether a given individual will develop rheumatic fever after a streptococcal pharyngitis have not been clarified. The low incidence of this disease, despite the prevalence of streptococcal respiratory infections, and the high familial incidence suggest a genetic factor. A recent study, however, shows that rheumatic fever does not follow the pattern of a simple recessive gene (1). Rheumatic symptoms develop after mild as well as severe infections due to any one of 50 known types of Group A Streptococci. Attempts to prove that any particular cellular component or enzyme produced by these organisms is the cause of this disease have so far proved negative. Rheumatic fever is uncommon in children less than five years of age. The mean titers of antistreptococcal antibodies in patients with acute rheumatic fever tend to be higher than in children with uncomplicated streptococcal infections (2). These observations suggested that repeated, closely spaced attacks of streptococcal pharyngitis may be a determining factor (3). It is usually not possible to obtain a reliable history of remote respiratory infections. Furthermore, even if the illness is recalled, streptococcal pharyngitis usually cannot be differentiated from a sore throat of viral origin. The commonly studied antistreptococcal antibodies, such as antistreptolysin 0, are not type-specific and may show a rise in titer after infection with any one of the 50 types of Group A Streptococci. These antibodies usually appear one to two weeks after the infection and in most instances return to normal levels after two to six months. The only antibody indicative of a type-specific streptococcal infection is the one directed against

STUDIES ON TYPE-SPECIFIC STREPTOCOCCAL ANTIBODIES AS INDICATORS OF PREVIOUS STREPTOCOCCAL INFECTIONS IN RHEUMATIC AND NONRHEUMATIC CHILDREN*