Recurrences of acute rheumatic fever. A prospective study of 79 episodes

Fifty-three patients with acute rheumatic fever and 79 recurrences were studied prospectively for six years. All the patients were examined by the same physicians during their initial attack, as well as during recurrences. Of the 27 patients with carditis in the initial attack, all had persistence of cardiac involvement during subsequent recurrences, and some additional involvement developed. Of the 26 patients without carditis in the initial attack, only two patients who initially had pure chorea also had chorea and carditis in recurrences. These data strongly support the concept that if the host escapes carditis in the initial attack, he/she will continue to do so in subsequent recurrences; however, if the heart is involved in the initial attack, recurrences can inflict further cardiac damage. In view of these findings, the current approach to prophylaxis should probably be modified.