Abstract
In our 2021 article, we reported that Streptococcus pyogenes (Strep A) detection, both in throat swabs and skin swabs, was associated with an increased risk of acute rheumatic fever (ARF). This elevated risk was concentrated during the 8–90 days following swab collection. While Strep A pharyngitis is a well-established driver of ARF, we provided the first population-level evidence that Strep A skin infections can independently trigger ARF. There is occasional evidence in the international literature that infection with other Lancefield groups, notably Group C and G, may also trigger ARF, although this exposure does not appear to be a major driver of disease. It is, however, important to investigate this possibility to help assess the clinical significance of superficial Group C and G infections.