OF THE MAJOR criteria for the diagnosis of acute rheumatic fever—carditis, arthritis, subcutaneous nodules, erythema marginatum, and chorea—only carditis may result in permanent, residual damage.1 An episode of acute rheumatic fever without clinical evidence of carditis is often, therefore, considered an essentially benign illness; nevertheless, it must be determined whether the patient incurring acute rheumatic fever without clinical carditis is equally susceptible to a recurrent attack as is the patient who has acute rheumatic fever with residual cardiac damage. It must also be determined how frequently a patient without clinical carditis during the initial attack of rheumatic fever develops carditis with a subsequent episode. These factors should determine the necessity of continuous, long-term chemoprophylaxis in patients who have had rheumatic fever without clinical evidence of carditis.
Review of the Literature
Streptococcal Infection.—Many streptococcal infections are not clinically recognizable. Therefore, although a rheumatic fever recurrence occurs more frequently after