Facts and fallacies about streptococcal infection and rheumatic fever.

Recent outbreaks of acute rheumatic fever (ARF) in the United States are drawing attention to a previously declining disease. Authorities agree that penicillin treatment of group A beta-hemolytic streptococcus (GABHS) pharyngitis contributed to the decline in incidence and severity of ARF. However, because the pathogenic mechanism that links GABHS and ARF is still a debatable issue, the cause of the recent outbreaks is unknown. A review of the current literature generates interesting questions about the current status of ARF and common GABHS testing and treatment practices. Facts about GABHS and ARF and current recommendations for the diagnosis and treatment of GABHS pharyngitis are presented.