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Clinical Dilemmas in the Use of Penicillin in Streptococcal Illness

Henry S. Harvey, MD; Marjorie B. Dunlap, MA
Am J Dis Child. 1967;114(3):244-252. doi:10.1001/archpedi.1967.02090240058002.
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IN A COMPANION article,1 we have presented evidence that the carrier state, with or without preliminary illness, can lead to type-specific immunity to streptococcal infection. We had guessed that this might be true from our clinical observations of the 150 families in a research program.2-4 Our expectations have been confirmed by the precise identification possible by the Lancefield precipitin technique of M protein determination: illness does not result from the carried type, but from a new type, against which no immunity has been established. The existence of anti-M protein antibodies in the sera of known carriers has been demonstrated by means of the long-chain test of Stollerman and Ekstedt.5 Persons who have harbored a specific type for a number of weeks or months develop these antibodies, in contrast to those whose experience with it is brief, and presumably this development of type-specific antibodies is one factor in


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