The reemergence of serious group A streptococcal infections and acute rheumatic fever

Am J Med Sci. 1996 Jan;311(1):41-54. doi: 10.1097/00000441-199601000-00008.


Acute rheumatic fever and life-threatening group A streptococcal infections have reemerged during the past 15 years to once again become a serious health threat in the developed countries of the world. Reports of outbreaks of acute rheumatic fever in many parts of this country and others have shattered the complacency that the health-care community had acquired related to this devastating sequela of streptococcal pharyngitis. Invasive streptococcal infections, often associated with loss of limbs of life despite optimal antibiotic therapy, have underscored the potential virulence of these organisms. A new clinical entity, streptococcal toxic shock syndrome, has emerged as a consequence of the new invasive strains of group A streptococci. In this article, the authors summarize the recent changes in the epidemiology of group A streptococcal infections and rheumatic fever and review the potential reasons for the increased virulence of these organisms. In addition, they discuss prospects for a streptococcal M protein vaccine designed to control these infections and their sequelae.

Publication types

  • Review

MeSH terms

  • Anti-Bacterial Agents / therapeutic use
  • Demography
  • Developing Countries
  • Disease Outbreaks*
  • Humans
  • Incidence
  • Rheumatic Fever / drug therapy
  • Rheumatic Fever / epidemiology*
  • Shock, Septic / epidemiology
  • Socioeconomic Factors
  • Streptococcal Infections / drug therapy
  • Streptococcal Infections / epidemiology*
  • Streptococcus pyogenes* / pathogenicity
  • United States / epidemiology
  • Virulence


  • Anti-Bacterial Agents