Unusual instances of infection with streptococcus scarlatinae.

Abstract

In the preceding study we noted that infections of the throat with scarlatinal streptococci may occur during an epidemic of scarlet fever, and that these infections are not accompanied by a rash. There is also clinical and epidemiological evidence that these cases may be responsible for cases of clinical scarlet fever among contacts. Williams has recently found this streptococcus in osteomyelitis, endocarditis and in chronically inflamed tonsils, so that we may be assured that Streptococcus scarlatinœ is a rather widely distributed organism and is not confined in its distribution to the cases diagnosed as clinical scarlet fever.

We know little concerning the clinical manifestations of Streptococcus scarlatinœ in conditions other than the usual angina with the scarlatina-form rash because the methods of identification are so recent that few observations have accumulated. Some of the infections are associated with a rash as in wound scarlet fever, yet we know that the infection may take place without cutaneous manifestations. The original strain for the toxin made by Dick and Dick was obtained from the infected finger of a nurse caring for a scarlet fever patient. In this instance no rash was reported.

The study of such atypical infections is important from the epidermiologic standpoint. Unfortunately, there is but little opportunity to study such cases in infectious hospitals because they are seldom recognized unless they occur among known scarlatinal contacts, or unless they are uncovered in an attempt to account for a case of scarlet fever without known exposure. During the past two years we have been able to collect data on six cases of infection with Streptococcus scarlatinæ which did not present the usual rash, yet occurred among contacts of scarlatina or were apparently the source of scarlatinal infection in others.