Streptococcal rheumatic carditis.

INTRODUCTION................................................................... 97 A BRIEF HISTORY .............. .................................................... 98 ETIOLOGY: EVIDENCE FOR THE GROUP A STREPTOCOCCAL ETIOLOGY OF RHEUMATIC FEVER ................................. ................................. 98 Immunological Evidence.................................................................. 99 M-protein ...................................................................99 (i) Clinical evidence................................................................... 99 (ii) Experimental evidence .................................................................. 9 Complexes of mucopeptide and polysaccharide..................................................... 100 Mucopeptide................................................................... 100 Persisting, degraded streptococci.................................................................. 101 Streptococcal antigens cross-reactive with tissues .................................................. 101 PATHOLOGY OF RHEUMATIC FEVER................................................................ 102 General Pathology .................................................................. 102 The nature of the rheumatic lesion: the Aschoff body ............................................ 102 The nature of fibrinold................................................................... 103 ROLE OF THE IMMUNE SYSTEM IN THE PATHOGENESIS OF RHEUMATIC FEVER 103 Pathogenesis ................................................................... 103 Possible Role of Immunological Mechanisms in the Disease........................................ 103 Immunological Theories ...................... ............................................. 104 Allergic theories ............... .................................................... 104 (i) Supportive experimental evidence-humoral immune aspects ........................... 104 (ii) Supportive experimental evidence-cellular immune aspects............................ 105 Autoimmune theory ................. ................................................. 106 (i) Supportive experimental evidence-humoral immune aspects ........................... 106 (a) Heart antibodies .......................... ......................................... 106 (b) Cross-reactions between streptococci and human heart .......... ..................... 107 (ii) Supportive experimental evidence-cellular immune aspects............................ 108 EXPERIMENTAL MODELS FOR THE PATHOGENESIS OF RHEUMATIC HEART DISEASE.................................................................. 109 The Murphy-Swift Model .................................................................. 109 Other Models That Use Streptococci or Their Components........................................ 110 Models That Use Immunological Procedures........................................................... 110 Experimental systems to eludicate the allergic nature of rheumatic carditis ................ 110 Autoimmunization models .............................. .................................... 110 Virusmodels .................................................................. 111 IMMUNOGENETIC ASPECTS OF RHEUMATIC FEVER .............. ........................... 111 CONCLUDING REMARKS .......................... ......................................... 112 LITERATURE CITED ................ .................................................. 113