[The changing clinical pattern of rheumatic fever (author's transl)]

During the last years a remarkable change in the pattern of rheumatic fever has been observed. Severe carditis and polyarthritis have almost disappeared. Accordingly the mortality rate decreased considerably milder forms of rheumatic fever may become a diagnostical problem so that adequate therapy may be delayed. These cases may present as chronic heart disease with an unspecific history. The modified Jones criteria alone have limited value. Laboratory tests are increasingly important. Not only improvement of hygiene or therapy with Penicillin are causes for the declining incidence of rheumatic fever, but also the change in the behaviour of Streptococci. This assumption will be supported if the equally dranged course of scarlet fever and the uniform ASO-titers in children as a measure for contacts with Streptococci are taken into account.