Top

European Journal of Clinical Microbiology & Infectious Diseases

Published in:

01-05-2015 | Review

ASO titer or not? When to use streptococcal serology: a guide for clinicians

Authors: T. Parks, P. R. Smeesters, N. Curtis, A. C. Steer

Published in: European Journal of Clinical Microbiology & Infectious Diseases | Issue 5/2015

Abstract

Clinicians frequently request serologic tests to provide evidence of prior infection by Streptococcus pyogenes, especially when suspecting a diagnosis of acute rheumatic fever or post-streptococcal glomerulonephritis. However, the interpretation of these tests is difficult and should take account of the clinical features, epidemiological setting, and pre-test probability, as well as the specific aspects of the assay. This review details the characteristics of streptococcal serologic assays and provides recommendations for their use and interpretation.

Carapetis JR, Steer AC, Mulholland EK, Weber M (2005) The global burden of group A streptococcal diseases. Lancet Infect Dis 5:685–694. doi:10.1016/S1473-3099(05)70267-X CrossRefPubMed

Tandon R, Sharma M, Chandrashekhar Y, Kotb M, Yacoub MH, Narula J (2013) Revisiting the pathogenesis of rheumatic fever and carditis. Nat Rev Cardiol 10:171–177. doi:10.1038/nrcardio.2012.197 CrossRefPubMed

Rodríguez-Iturbe B, Batsford S (2007) Pathogenesis of poststreptococcal glomerulonephritis a century after Clemens von Pirquet. Kidney Int 71:1094–1104. doi:10.1038/sj.ki.5002169 CrossRefPubMed

Johnson DR, Kurlan R, Leckman J, Kaplan EL (2010) The human immune response to streptococcal extracellular antigens: clinical, diagnostic, and potential pathogenetic implications. Clin Infect Dis 15(50):481–490. doi:10.1086/650167 CrossRef

Kurlan R, Johnson D, Kaplan EL; Tourette Syndrome Study Group (2008) Streptococcal infection and exacerbations of childhood tics and obsessive–compulsive symptoms: a prospective blinded cohort study. Pediatrics 121:1188–1197. doi:10.1542/peds.2007-2657 CrossRefPubMed

Shulman ST, Bisno AL, Clegg HW, Gerber MA, Kaplan EL, Lee G et al (2012) Clinical practice guideline for the diagnosis and management of group A streptococcal pharyngitis: 2012 update by the Infectious Diseases Society of America. Clin Infect Dis 15(55):1279–1282. doi:10.1093/cid/cis847 CrossRef

Wannamaker LW, Ayoub EM (1960) Antibody titers in acute rheumatic fever. Circulation 21:598–614CrossRefPubMed

Walker MJ, Barnett TC, McArthur JD, Cole JN, Gillen CM, Henningham A et al (2014) Disease manifestations and pathogenic mechanisms of group A Streptococcus. Clin Microbiol Rev 27:264–301. doi:10.1128/CMR.00101-13 CrossRefPubMedCentralPubMed

Shet A, Kaplan EL (2002) Clinical use and interpretation of group A streptococcal antibody tests: a practical approach for the pediatrician or primary care physician. Pediatr Infect Dis J 21:420–426, quiz 427–30CrossRefPubMed

10.

Kaplan EL, Huew BB (1980) The sensitivity and specificity of an agglutination test for antibodies to streptococcal extracellular antigens: a quantitative analysis and comparison of the streptozyme test with the anti-streptolysin O and anti-deoxyribonuclease B tests. J Pediatr 96:367–373CrossRefPubMed

11.

Gerber MA, Wright LL, Randolph MF (1987) Streptozyme® test for antibodies to group A streptococcal antigens. Pediatr Infect Dis J 6:36–40CrossRefPubMed

12.

Todd EW (1938) The differentiation of two distinct serological varieties of streptolysin, streptolysin O and streptolysin S. J Path Bact 47:423CrossRef

13.

Alouf JE (1980) Streptococcal toxins (streptolysin O, streptolysin S, erythrogenic toxin). Pharmacol Ther 11:661–717CrossRefPubMed

14.

Johnson DR, Kaplan EL, Sramek J, Bicova R, Havlicek J, Havlickova H et al (1996) Laboratory diagnosis of group A streptococcal infections. World Health Organization, Geneva

15.

Spaun J, Bentzon MW, Larsen SO, Hewitt LF (1961) International standard for antistreptolysin-O. Bull World Health Organ 24:271–279PubMedCentralPubMed

16.

Walker MJ, Hollands A, Sanderson-Smith ML, Cole JN, Kirk JK, Henningham A et al (2007) DNase Sda1 provides selection pressure for a switch to invasive group A streptococcal infection. Nat Med 13:981–985. doi:10.1038/nm1612 CrossRefPubMed

17.

Ayoub EM, Wannamaker LW (1962) Evaluation of the streptococcal deoxyribonuclease B and diphosphopyridine nucleotide antibody tests in acute rheumatic fever and acute glomerulonephritis. Pediatrics 29:527–538

18.

Kaplan EL, Anthony BF, Chapman SS, Ayoub EM, Wannamaker LW (1970) The influence of the site of infection on the immune response to group A streptococci. J Clin Invest 49(7):1405–1414. doi:10.1172/JCI106358 CrossRefPubMedCentralPubMed

19.

Kaplan EL, Rothermel CD, Johnson DR (1998) Antistreptolysin O and anti-deoxyribonuclease B titers: normal values for children ages 2 to 12 in the United States. Pediatrics 101:86–88CrossRefPubMed

20.

Danchin MH, Carlin JB, Devenish W, Nolan TM, Carapetis JR (2005) New normal ranges of antistreptolysin O and antideoxyribonuclease B titres for Australian children. J Paediatr Child Health 41:583–586. doi:10.1111/j.1440-1754.2005.00726.x CrossRefPubMed

21.

Steer AC, Vidmar S, Ritika R, Kado J, Batzloff M, Jenney AWJ et al (2009) Normal ranges of streptococcal antibody titers are similar whether streptococci are endemic to the setting or not. Clin Vaccine Immunol 16:172–5. doi:10.1128/CVI.00291-08 CrossRefPubMedCentralPubMed

22.

Karmarkar MG, Venugopal V, Joshi L, Kamboj R (2004) Evaluation & revaluation of upper limits of normal values of anti-streptolysin O & anti-deoxyribonuclease B in Mumbai. Indian J Med Res 119(Suppl):26–28PubMed

23.

[No authors listed] (1992) Guidelines for the diagnosis of rheumatic fever. Jones Criteria, 1992 update. Special Writing Group of the Committee on Rheumatic Fever, Endocarditis, and Kawasaki Disease of the Council on Cardiovascular Disease in the Young of the American Heart Association. JAMA 268:2069–2073CrossRef

24.

Pelloux H, Fricker-Hidalgo H, Brochier G, Goullier-Fleuret A, Ambroise-Thomas P (1999) Intravenous immunoglobulin therapy: confounding effects on serological screening for toxoplasmosis during pregnancy. J Clin Microbiol 37:3423–3424PubMedCentralPubMed

25.

Lichtiger B, Rogge K (1991) Spurious serologic test results in patients receiving infusions of intravenous immune gammaglobulin. Arch Pathol Lab Med 115:467–469PubMed

26.

Hill HR (2010) Group A streptococcal carrier versus acute infection: the continuing dilemma. Clin Infect Dis 15(50):491–492. doi:10.1086/650168 CrossRef

27.

RHDAustralia (ARF/RHD writing group), National Heart Foundation of Australia and the Cardiac Society of Australia and New Zealand, Carapetis JR, Brown A, Maguire G, Walsh W, Noonan S, Thompson D (2012) Australian guideline for prevention, diagnosis and management of acute rheumatic fever and rheumatic heart disease (2nd edition). Available online at: http://www.rhdaustralia.org.au/resources/arf-rhd-guideline

28.

Klein GC, Baker CN, Jones WL (1971) “Upper limits of normal” antistreptolysin O and antideoxyribonuclease B titers. Appl Microbiol 21:999–1001PubMedCentralPubMed

Title: ASO titer or not? When to use streptococcal serology: a guide for clinicians
Authors: T. Parks
P. R. Smeesters
N. Curtis
A. C. Steer
Publication date: 01-05-2015
Publisher: Springer Berlin Heidelberg
Published in: European Journal of Clinical Microbiology & Infectious Diseases / Issue 5/2015
Print ISSN: 0934-9723
Electronic ISSN: 1435-4373
DOI: https://doi.org/10.1007/s10096-014-2303-8

Live Webinar | 27-06-2024 | 18:00 (CEST)

Keynote webinar | Spotlight on medication adherence

Reserve your place

Live: Thursday 27th June 2024, 18:00-19:30 (CEST)

WHO estimates that half of all patients worldwide are non-adherent to their prescribed medication. The consequences of poor adherence can be catastrophic, on both the individual and population level.

Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.

Prof. Kevin Dolgin

Prof. Florian Limbourg

Prof. Anoop Chauhan

Developed by: Springer Medicine

Obesity Clinical Trial Summary

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.

Developed by: Springer Medicine

2024 ASCO Annual Meeting

Springer Medicine

Abstract

Please log in to get access to this content

Other articles of this Issue 5/2015

Microarray identification of bacterial species in peritonsillar abscesses

The levels of antibodies to Panton–Valentine leukocidin (PVL) vary with PVL prevalence along a north-to-south gradient

The RIG-I-like helicase receptor MDA5 (IFIH1) is involved in the host defense against Candida infections

Faecal carriage of carbapenemase-producing Gram-negative bacilli in hospital settings in southern France

Performance of different culture methods and of a commercial molecular assay for the detection of carbapenemase-producing Enterobacteriaceae in nursing homes and rehabilitation centers

Insights into bacterial colonization of intensive care patients’ skin: the effect of chlorhexidine daily bathing

Keynote webinar | Spotlight on medication adherence

Live: Thursday 27th June 2024, 18:00-19:30 (CEST)

At a glance: The STEP trials