Two methods were employed in a study to ascertain whether the identification of a specific bacterial antigen or antibodies activated by it could be the means of determining rheumatic fever activity. The first method was by a hemolytic test with patient's serum as the antibody source and artificially sensitized sheep erythrocytes as the antigen. The second method was by an agglutination test using rabbit antiserum and patient's erythrocytes sensitized in vivo as the antigen. Clinical correlations were obtained with 78 rheumatic fever patients. There were 77 control cases. The methods proved practical in ascertaining rheumatic fever activity or quiescence and in distinguishing rheumatic fever from other disease processes.The principle of a specific antigen-antibody reaction has been the basis of numerous tests to identify infectious diseases.* Erythrocytes that have been coated or sensitized by an antigen react with a specific antiserum prepared from that antigen to produce agglutination of the coated red cells.\s=d\ When complement is added to this reaction, hemolysis occurs under certain conditions. Because the manifestations of rheumatic fever are asso¬ ciated with Group A beta-hemolytic Strep¬ tococcus, it was the purpose of this study to ascertain whether a means of identifying a specific bacterial antigen, or the antibodies elicited by it, could likewise determine rheu¬ matic fever activity. It was postulated that the bacteria producing this tissue response possess a common antigen which is responsi¬ ble for the manifestations of rheumatic fever.
METHODS OF STUDYTwo methods of determination were employed in this study. To demonstrate the presence of a specific antibody in the serum of rheumatic fever patients, sheep red cells were coated with heat-killed Group A beta-hemolytic streptococci, which had been iso¬ lated as the actual etiologic agents in active rheu¬ matic fever patients. The coated red cells were then incubated with each patient's serum, and comple¬ ment was added to produce hemolysis when the patient's serum contained the specific antibodies.The second method employed Group A betahemolytic Streptococcus antiserum obtained by im¬ munizing rabbits. The rheumatic fever patient's red cells were added to this antiserum to produce ag¬ glutination when the patient's cells were coated with the specific antigen.
Preparation of Antigen MediaBrain-heart infusion (Difco product), 37 gm., was dissolved in 1000 cc. of distilled water and sterilized in the autoclave at 15 lb. pressure (121 C) for 20 minutes. If the medium was not to be used the same day that it was sterilized, it was placed in flowing steam or boiling water for a few moments to drive off dissolved gases and cooled without agi¬ tation. Part of the brain-heart infusion was dis¬ pensed into small test tubes to which freshly washed sterile sheep cells were added so that each tube con¬ tained 10 cc. of a 0.5% cell suspension. The remain¬ ing brain-heart infusion was dispensed into larger test tubes to which sterile horse serum was added so that eac...