STREPTOCOCCI IN INFECTIOUS (ATROPHIC) ARTHRITIS AND RHEUMATIC FEVER

Area of Science:

• Microbiology
• Rheumatology
• Infectious Diseases

Background:

• The etiological role of streptococci in infectious arthritis and rheumatic fever remains a critical question in medical research.
• Previous studies have reported inconsistent findings regarding the presence of streptococci in blood cultures and affected tissues of patients with these conditions.
• The possibility of streptococcal infection is plausible due to the frequent occurrence of associated throat, sinus, or focal infections.

Purpose of the Study:

• To critically evaluate the evidence for streptococcal involvement in the etiology of infectious arthritis and rheumatic fever.
• To investigate the consistency and significance of streptococcal findings in clinical cultures.
• To identify potential sources of error, such as contamination, in the isolation of streptococci from patient samples.

Main Methods:

• Review and analysis of existing literature on streptococcal isolation from patients with rheumatic fever and infectious arthritis.
• Comparison of findings from various research groups, noting inconsistencies and peculiarities.
• Consideration of cultural techniques, contamination risks, and the interpretation of bacterial findings, including differentiating contaminants from true pathogens.

Main Results:

• Significant inconsistencies exist among studies reporting streptococcal recovery from blood cultures and tissues in rheumatic fever and infectious arthritis.
• Some studies reported various streptococcal types (e.g., Streptococcus viridans, non-hemolytic streptococci) and other bacteria (diphtheroids, staphylococci).
• The current study's attempts to replicate previous findings, particularly those of Cecil et al., failed to confirm their results, with isolated organisms often deemed contaminants.

Conclusions:

• The inconsistent and often unrepeatable findings raise doubts about the etiological role of streptococci in infectious arthritis and rheumatic fever.
• Contamination during laboratory culturing is a significant concern that can explain the varied and sometimes positive results reported.
• Consistent recovery of streptococci by multiple independent research groups, using rigorous methods and negative controls, is essential before their causative role can be accepted.