title: Continued high caseload of rheumatic fever in western Pennsylvania: Possible rheumatogenic emm types of streptococcus pyogenes.
abstract: OBJECTIVE
  To evaluate the occurrence of cases of acute rheumatic fever (ARF) in western Pennsylvania although there has been a marked reduction of cases of ARF in the United States overall.
  
  
  METHODS
  From 1994 to 2003, the cases of ARF evaluated at Children's Hospital of Pittsburgh were reviewed. In addition, throat cultures were performed on a subset of these children and their family members beginning in 1995. Molecular typing was performed on isolates of the group A streptococcus (GAS) recovered, using field inversion gel electrophoresis (FIGE) and emm typing.
  
  
  RESULTS
  There were 121 new cases of ARF from 1994 to 2003. Of these, 57% were male. The median age was 10 years. The majority of children (57%) had carditis with or without another manifestation of ARF. The results of throat cultures were available for 231 persons; 36% (30/84) of the children with ARF and 14% (20/147) of family members were positive for GAS. Eight emm types were observed (emm 1, 2, 6, 12, 18, 28, 75, and 89). Data suggest that emm type 12 may be a rheumatogenic strain.
  
  
  CONCLUSIONS
  ARF remains a problem in western Pennsylvania. Identification of emm types associated with cases should enlighten vaccine development.
authors.affiliation: Department of Pediatrics, Division of Allergy, Immunology and Infectious Diseases, Children's Hospital of Pittsburgh, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA.
authors.forename: Judith Marie
authors.initials: JM
authors.lastname: Martin
authors.forename: Karen A
authors.initials: KA
authors.lastname: Barbadora
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D015373:Bacterial Typing Techniques; D002648:Child; D002675:Child, Preschool; D004269:DNA, Bacterial / Q000032:analysis; D005190:Family; D005260:Female; D006801:Humans; D008297:Male; D010414:Pennsylvania / Q000453:epidemiology; D010614:Pharynx / Q000382:microbiology; D011446:Prospective Studies; D012213:Rheumatic Fever / Q000453:epidemiology* / Q000382:microbiology*; D013297:Streptococcus pyogenes / Q000145:classification* / Q000235:genetics / Q000302:isolation & purification
chemical_list: D004269:DNA, Bacterial