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

Kaplan, Edward L.; Huwe, Barbara B.

doi:10.1016/s0022-3476(80)80674-3

Cited by 30 publications

(16 citation statements)

References 17 publications

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“…Um resultado isolado de ASO pode ter baixa sensibilidade, impondo uma outra limitação quanto à utilidade da determinação da ASO, pois nem todos os pacientes respondem com aumento deste anticorpo. Esta dificuldade pode ser superada pela determinação combinada de outros anticorpos anti-estreptocócicos como a anti-desoxirribonuclease B, anti-hialuronidase, antiestreptoquinase, anti-estreptodornase 32 , ou pela determinação seriada da ASO. Contudo, este recurso pode ter a relação de custo-benefício alta, de tal forma que um teste isolado pode ter maior valor para o diagnóstico quando os títulos ultrapassem 640 UI/ml.…”

Section: Discussionunclassified

Antistreptolysin O titer profile in acute rheumatic fever diagnosis

Machado¹,

Ortiz²,

Martins³

et al. 2001

J Pediatr (Rio J)

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ResumoObjetivo: estabelecer o perfil dos títulos de ASO, mediante o diagnóstico diferencial da FRA com outras afecções que também cursam com níveis elevados de ASO.Métodos: foram estudados 78 casos de FRA na apresentação e seguimento, 22 de coréia isolada, 45 de infecções orofaringeanas recorrentes (IOR) e 23 de artrites idiopáticas juvenis (AIJ), com início ou reativação recente. A determinação seqüencial de ASO (UI/ml) foi realizada por ensaio nefelométrico automatizado (Behring ® -Germany) nos períodos de 0-7 dias, 1-2 semanas, 2-4 semanas, 1-2 meses, 2-4 meses, 4-6 meses, 6-12 meses, 1-2 anos, 2-3 anos, 3-4 anos e 4-5 anos após o diagnóstico.Resultados: os títulos de ASO na fase aguda da FRA apresentaram elevação significante até o intervalo de 2-4 meses (p<0,0001), quando atingiram os níveis basais e permaneceram estáveis por 5 anos na vigência de profilaxia secundária com penicilina. Os valores de ASO na apresentação da FRA também foram mais elevados e com diferença significante quando comparados aos de coréia isolada, IOR e AIJ (p=0,0025). As variações etárias e o limite superior da normalidade (320 UI/ml) foram considerados para a comparação entre estes grupos, assim como para o cálculo da sensibilidade (73,3%) e da especificidade (57,6%) mediante o diagnóstico clínico de FRA. A especificidade e valor preditivo positivo do teste aumentaram com títulos crescentes, sendo mais alta com títulos >960 UI/ml.Conclusão: esta reavaliação do perfil da ASO indicou uma resposta exuberante na fase aguda da febre reumática indicou ainda que os seus níveis séricos podem diferenciá-la de outras afecções que também cursam com níveis elevados de ASO, como as infecções orofaringeanas recorrentes ou as artrites idiopáticas juvenis em atividade.J Pediatr (Rio J) 2001; 77 (2):105-11: artrite, febre reumática, antiestreptolisina, coréia. AbstractObjective: to determine ASO titer profile by establishing ARF differential diagnoses of other diseases with high levels of ASO antibodies.Methods: we investigated 78 patients with ARF at onset and follow-up, 22 with isolated chorea at onset, 45 with recurrent oropharyngeal tonsillitis, and 23 with recent flare of juvenile idiopathic arthritis. We tested ASO with automated particle-enhanced immunonephelometric assay (Behring ® -Germany). The ASO (IU/ ml) titers were assessed at the following time intervals: 0-7 days, 1-2 weeks, 2-4 weeks, 1-2 months, 2-4 months, 4-6 months, 6-12 months, 1-2 years, 2-3 years, 3-4 years, and 4-5 years after onset of ARF.Results: ASO titers in patients diagnosed with ARF had a significant increase up to the 2-4-month time interval (P<0.0001). Baseline levels were observed afterwards in patients under regular penicillin prophylaxis. The levels of ASO in ARF were also significantly higher than in patients with isolated chorea, recurrent oropharyngeal infections or juvenile idiopathic arthritis (P=0.0025), when age-matched samples of these groups were compared. The test's sensitivity was 73.3% and the specificity was 57.6%, and it was calculated taking into a...

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Section: Discussionunclassified

Antistreptolysin O titer profile in acute rheumatic fever diagnosis

Machado¹,

Ortiz²,

Martins³

et al. 2001

J Pediatr (Rio J)

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“…This test is less well standardized and less reproducible than other antibody tests, and it should not be used as a test for evidence of a preceding GAS infection (Class III, LOE B). 27,28 …”

Section: Streptococcal Antibody Testsmentioning

confidence: 99%

Prevention of Rheumatic Fever and Diagnosis and Treatment of Acute Streptococcal Pharyngitis

Gerber¹,

et al. 2009

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Abstract-Primary prevention of acute rheumatic fever is accomplished by proper identification and adequate antibiotic treatment of group A ␤-hemolytic streptococcal (GAS) tonsillopharyngitis. Diagnosis of GAS pharyngitis is best accomplished by combining clinical judgment with diagnostic test results, the criterion standard of which is the throat culture. Penicillin (either oral penicillin V or injectable benzathine penicillin) is the treatment of choice, because it is cost-effective, has a narrow spectrum of activity, and has long-standing proven efficacy, and GAS resistant to penicillin have not been documented. For penicillin-allergic individuals, acceptable alternatives include a narrow-spectrum oral cephalosporin, oral clindamycin, or various oral macrolides or azalides. The individual who has had an attack of rheumatic fever is at very high risk of developing recurrences after subsequent GAS pharyngitis and needs continuous antimicrobial prophylaxis to prevent such recurrences (secondary prevention). The recommended duration of prophylaxis depends on the number of previous attacks, the time elapsed since the last attack, the risk of exposure to GAS infections, the age of the patient, and the presence or absence of cardiac involvement. Penicillin is again the agent of choice for secondary prophylaxis, but sulfadiazine or a macrolide or azalide are acceptable alternatives in penicillin-allergic individuals. This report updates the 1995 statement by the American Heart Association Rheumatic Fever, Endocarditis, and Kawasaki Disease Committee. It includes new recommendations for the diagnosis and treatment of GAS pharyngitis, as well as for the secondary prevention of rheumatic fever, and classifies the strength of the recommendations and level of evidence supporting them. (Circulation. 2009;119:1541-1551.)

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“…The presence of an elevated ASOT does, however, add strong diagnostic relevance. The streptozyme agglutination test is often used as a screening test for antibodies to streptococcal antigens, NADase, DNase, streptokinase, streptolysin O, and hyaluronidase (Kaplan & Huew 1980). Streptozyme has two advantages over ASOT.…”

Section: Discussionmentioning

confidence: 99%

Post‐streptococcal uveitis

Gallagher

Muqit

Jones

et al. 2006

Acta Ophthalmologica Scandinavica

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ABSTRACT.Purpose: To describe the clinical features of post-streptococcal uveitis (PSU) and examine management strategies in the treatment of this under-recognized condition. Methods: Patients were identified from the world literature using the Pubmed search engine. We examined two new cases of post-streptococcal intermediate uveitis. The epidemiology, immune mechanisms, clinical features, investigations, treatments and visual outcomes were examined and recorded. Results: We reviewed 11 patients including our own two cases. There was a statistically significant seasonal difference in antistreptolysin-O titres (ASOT), and age-related ASOT was identified. Of the 11 patients, eight (72.7%) had anterior uveitis, two (18.2%) had intermediate uveitis and one (9.1%) had panuveitis. Their ages ranged from 5 to 56 years (mean 17 years). The majority of cases had significantly elevated ASOT; most patients were treated with topical steroids and oral antibiotics and four cases underwent adenotonsillectomy. The visual prognosis was good in most cases. Conclusions: Uveitis may be the sole presenting clinical feature, or it may occur in combination with other features of post-streptococcal infection. Ophthalmologists should be aware of the clinical features of PSU and maintain a high level of suspicion, particularly in childhood uveitis.

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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

Cited by 30 publications

References 17 publications

Antistreptolysin O titer profile in acute rheumatic fever diagnosis

Antistreptolysin O titer profile in acute rheumatic fever diagnosis

Prevention of Rheumatic Fever and Diagnosis and Treatment of Acute Streptococcal Pharyngitis

Post‐streptococcal uveitis

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