Hutten-Czapski P. Management of streptococcal pharyngitis: the conundrum of acute rheumatic fever.Family Practice1988; 5: 200–208.The incidence of acute rheumatic fever in the residents of three counties in Ontario (population 507 300) from 1975 to 1986 inclusive was 0.17 hospitalized cases per 100 000 population (0.4 per 100000 for 5-to 19-year-olds). Indigent patients (0.6 per 100000) and North American Indians (2 per 100000) had substantially higher rates. This experience is in marked contrast to recent outbreaks of acute rheumatic fever in areas of the United States, but is similar to experience in the United Kingdom. The implications of this data on the current management of the streptococcal sore throat is reviewed, showing the complexities of real-life prevention of acute rheumatic feve
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