The Role of Tonsils in Predisposing to Streptococcal Infections and Recurrences of Rheumatic Fever

The size of tonsils in 532 children and adolescents, all with previous attacks of rheumatic fever, was correlated with the subsequent development of streptococcal infections and rheumatic recurrences, as noted in monthly or bimonthly examinations. The size of tonsils did not significantly affect the incidence of infections or of rheumatic recurrences in patients who maintained good continuity of antistreptococcal prophylaxis. In patients who did not maintain good prophylaxis (an analogue of the situation in the preantibiotic era), an increasing size of tonsils was associated with significant increases in the rates of streptococcal infection and of rheumatic recurrence. The rising gradient in attack rates for increasing size of tonsils persisted even when patients were stratified according to age and cardiac status. The size of the tonsils did not affect the types of symptoms produced by streptococcal infections. These data support both the old and the new beliefs about the role of tonsils, and of prophylactic medication in preventing streptococcal infections in patients who have had rheumatic fever.