General Tuberculin-like Reactions in Rheumatic Fever Patients Following Intravenous Injection of Streptococcus Vaccines or Nucleoproteins.

Abstract

Several years ago one of us 1 suggested that rheumatic fever had many points of similarity with tuberculosis. Since then we^2,3 have shown that rabbits may be rendered hypersensitive to streptococci by the production of focal lesions with various types of non-hemolytic streptococci which have been isolated from patients with rheumatic fever and other diseases. As these streptococci have been shown 4 to belong to various immunological groups, we formulated the hypothesis that if they had any etiologic relationship with the disease it was because of a peculiar type of tissue reactivity acquired by the rheumatic patient. We have, therefore, tested the reactivity of a number of patients in the late stages of rheumatic fever to intravenous injection of streptococci or products derived from them. These test materials were heat killed suspensions, vaccines, prepared from both green and hemolytic streptococci and nucleoproteins made from hemolytic streptococci. In all instances the initial dosage was very small and subsequently increased by slow degrees in order to avoid too severe reactions.

The type of febrile reaction has been uniform, and consisted, as a rule, of slowly rising temperature which usually did not begin until 6 to 8 hours after the injection, and often did not reach its maximum until from 16 to 30 hours. In a few instances the fever has persisted for 2 to 4 days, but as a rule it has disappeared by the end of 36 hours. There was an accompanying increase in pulse rate, often headache, dizziness and general malaise. Chills or chilly sensations have been rare. In some cases there has been moderate reactivation of previously quiescent arthritis, and symptoms pointing to activation of cardiac foci.