Jermm.

com Original Research Article

UTILISATION OF ANTI-STREPTOLYSIN O ANTI-BODY AS SCREENING TEST

Deepali Danave1, K. V. Ingole2

1Associate Professor, Department of Microbiology, Dr. Vaishampayan Memorial Government Medical College, Solapur.
2Professor & HOD, Department of Microbiology, Dr.Vaishampayan Memorial Government Medical College, Solapur.

ABSTRACT
BACKGROUND
Streptococci produce two haemolysins, Streptolysin ‘O’ and ‘S’. Estimation of antibody (ASO titre) to Streptolysin ‘O’ is a standard
serological procedure for the retrospective diagnosis of infection with Streptococcus pyogenes. The purpose of our study was to
screen patients for presence of ASO, which would aid in the diagnosis of streptococcal infections.

MATERIALS AND METHODS

The study was carried for three months in a tertiary care centre; 84 clinically diagnosed cases of streptococcal infections and its
sequelae were chosen. Blood samples were collected from these patients and sent to the laboratory for detection of ASO titres. The
test kits used were IMMUNSTAR (LATEX SLIDE TEST) by Star Diagnostics Pvt. Ltd., Mumbai, India.

RESULTS
Out of 84 samples tested, we obtained 17 (20.23%) positive samples in our study. Paediatric (14 samples - 82.35%) and female
population (11 samples - 64.70%) outnumbered in positivity.

DISCUSSION
ASO titres have been used almost exclusively for epidemiological studies and the clinical diagnosis of S. pyogenes infection and its
sequelae such as rheumatic fever, glomerulonephritis and reactive arthritis after throat infections. Our study reports findings which
are in agreement with the results quoted in literature.

CONCLUSION
Determination of ASO in patients is a useful tool for co-relation with the diagnosis of streptococcal infections.

KEYWORDS
Anti-Streptolysin O (ASO), Streptococcal Infections.
HOW TO CITE THIS ARTICLE: Danave D, Ingole KV. Utilisation of anti-streptolysin O anti-body as screening test. Journal of
Evolution of Research in Medical Microbiology 2016; Vol. 2, Issue 2, July-December 2016; Page:1-2.
BACKGROUND MATERIALS AND METHODS
Streptococci produce several exotoxins and enzymes, which The study was carried out from June 2011 - December 2011 in
contribute to its virulence. Streptococci produce two a tertiary care centre. The subjects chosen were paediatric
haemolysins, Streptolysin ‘O’ and ‘S’. Streptolysin O is so called, patients and adult patients visiting the OPDs. These patients
because it is oxygen labile. It is antigenic and anti-streptolysin were clinically diagnosed with acute throat infections,
O appears in the sera following streptococcal infection. rheumatic fever, glomerulonephritis and reactive arthritis; 84
Estimation of this antibody (ASO titre) is a standard such clinically diagnosed cases were chosen. Blood samples
serological procedure for the retrospective diagnosis of were collected from these patients and sent to the laboratory
infection with Streptococcus pyogenes. Streptococcal antibody for detection of ASO titres. Sera were separated and subjected
tests are used for the diagnosis of infections caused by Group to latex agglutination test. Testing was carried out as per
A β-haemolytic Streptococci (GABHS) and are particularly manufacturer’s instructions. Positive or negative status of the
useful in the diagnosis of acute rheumatic fever and post- samples for ASO was reported. Since this was a screening test,
streptococcal glomerulonephritis.[1] A single titre of more than determination of titres was not done. The test kits used were
200 IU/mL is considered as raised value. Immunstar (Latex Slide Test) by Star Diagnostics Pvt. Ltd.
There is ongoing debate about the real utility of ASO titre Mumbai, India. Descriptive statistics were utilised during the
levels. In India most centres employ only a single ASO titre study.
during first outpatient contact at admission in making a
diagnosis of streptococcal infections. The purpose of our study RESULTS
was to screen patients for presence of ASO, which would aid in Positive samples 17 (20.23%)
the diagnosis of streptococcal infections.
s
Negative samples 67 (79.76%)
Financial or Other, Competing Interest: None. Total 84
Submission 24-08-2016, Peer Review 11-10-2016, Table 1. Distribution of Total Samples
Acceptance 21-10-2016, Published 19-12-2016.
Corresponding Author:
Dr. Deepali Danave, Paediatric Adult
Total
Department of Microbiology, Population Population
Dr. Vaishampayan Memorial Males 6 - 6 (35.29%)
Government Medical College, Females 8 3 11 (64.70%)
Solapur. Total 14 (82.35%) 3 (17.64%) 17
E-mail: milliondollarbaby@rediffmail.com
Table 2. Age-Wise and Sex-Wise
Distribution of Positive Samples

Journal of Evolution of Research in Medical Microbiology/ Vol. 2/ Issue 2/ July-December, 2016 Page 1
Jermm.com
Table 1 shows that we obtained 17 (20.23%) positive
samples in our study.
Table 2 shows the age and sex-wise pattern noticed in
these positive samples. The paediatric (14 samples - 82.35%)
and female population (11 samples - 64.70%) have
outnumbered their adult and male counterparts respectively.
DISCUSSION
Streptolysin ‘O’ is an exotoxin that repels leucocytes and
disrupts their membrane by pore forming or enzymatic attack
on phospholipids. It is produced by Group A, C and G
streptococci and Streptococcus canis.[2,3] The streptolysin ‘O’ of
S. pyogenes is within 90% genetic homology to the streptolysin
S of S. canis and of group C streptococci.[4]
In the infectious disease literature, ASO titres have been
used almost exclusively for epidemiological studies and the
clinical diagnosis of S. pyogenes infection[5,6] and its sequelae
such as rheumatic fever, glomerulonephritis and reactive
arthritis after throat infections.[7-9] Gray et al showed that a
single ASO titre greater than 400 U/mL correlated with a
sensitivity of 66% and specificity of 82% with upper
respiratory tract infections due to S. pyogenes in adults.[6]
According to the rheumatology literature, ASO titres may be
elevated in non-infectious arthritis[9] and sacroiliac joint
disorders in genetically susceptible patients. [10] β-haemolytic
streptococci may trigger reactive arthritis as well as rheumatic
fever.[9]
Our study reports similar findings where we detected ASO
in 82.35% of paediatric patients and 17.64% of adult patients.
This could be the result of streptococcal infection or its
sequelae. Presence of ASO in paediatric patients points
towards the possibility of upper respiratory tract infections
due to S. pyogenes or rheumatic fever. Various studies
conducted have reported the usefulness of ASO titre in the
diagnosis of rheumatic fever[11] and acute tonsillitis,[12] while
its presence in adult population is usually indicative of other
sequelae as reactive arthritis. Utility of ASO in the diagnosis of
orthopaedic infections has also been reported.[13]
Consequently, the distinction between reactive disease and
pyogenic infections has to be made clinically.
Limitations of our study include lack of ASO titre
determination. Nevertheless, reporting presence of ASO
definitely aided in the diagnosis of patients. ASO titre
determination is relatively inexpensive and accurate in the
diagnosis of 𝛽-haemolytic groups A, C and G streptococci.
Therefore, in patients with a compatible clinical
presentation, negative culture results and a positive result
from titre evaluation, antibiotics might be reduced to the
narrowest but highly active spectrum, i.e. penicillin.
CONCLUSION
Determination of ASO in patients is a useful tool for co-relation
with diagnosis of streptococcal infections.
Journal of Evolution of Research in Medical Microbiology/ Vol. 2/ Issue 2/ July-December, 2016
Original Research Article
REFERENCES
1. Martin DR, Voss LM, Walker SJ, et al. Acute rheumatic
fever in Auckland, New Zealand: spectrum of associated
group A streptococci different from expected. Pediatr
Infect Dis J 1994;13(4):264-9.
2. Gerlach D, Kohler W, Gunther E, et al. Purification and
characterization of streptolysin O secreted by
streptococcus equisimilis (Group C). Infect Immun
1993;61(6):2727-31.
3. Tiesler E, Trinks C. Release of extracellular metabolic
products by streptococci groups C and G. Zentralbl
Bakteriol Mikrobiol Hyg A 1982;253(1):81-7.
4. Okumura K, Hara A, Tanaka T, et al. Cloning and
sequencing the streptolysin O genes of group C and group
G streptococci. DNA Seq 1994;4(5):325-8.
5. Mhalu FS, Matre R. Antistreptolysin O and
antideoxyribonuclease B titres in blood donors and in
patients with features of non-suppurative sequelae of
group A streptococcus infection in Tanzania. East Afr Med
J 1995;72(1):33-6.
6. Gray GC, Struewing JP, Hyams KC, et al. Interpreting a
single antistreptolysin O test: a comparison of the ‘upper
limit of normal’ and likelihood ratio methods. J Clin
Epidemiol 1993;46(10):1181-5.
7. Jansen TL, Janssen M, de Jong AJ, et al. Post-streptococcal
reactive arthritis: a clinical and serological description,
revealing its distinction from acute rheumatic fever. J
Intern Med 1999;245(3):261-7.
8. Visser H, Speyer I, Ozcan B, et al. The diagnostic value of
streptococcal serology in early arthritis: a prospective
cohort study. Rheumatology 2000;39(12):1351-6.
9. Valtonen JM, Koskimies S, Miettinen A, et al. Various
rheumatic syndromes in adult patients associated with
high antistreptolysin O titres and their differential
diagnosis with rheumatic fever. Ann Rheum Dis
1993;52(7):527-30.
10. Chang ST, Ku CH, Cherng SC. Evidence based correlation
between anti-streptolysin O serum titre and sacroiliac
joint disorder. J Rheumatol 2007;34(8):1746-52.
11. Shetty A, D’Silva V. The utility of a single anti-streptolysin
O titre in the diagnosis of acute rheumatic fever. J of
Evolution of Med and Dent Sciences 2014;3(30):8372-7.
12. El-magd AA, Meguid MA, Tahan AERE. The value of high
anti-streptolysin O titre as an indicator of tonsillectomy in
upper Egypt. Int J of Otolaryngology and Head & Neck
Surgery 2016;5(1):1-5.
13. Uckay I, Ferry T, Stern R, et al. Use of serum anti-
streptolysin O titres in the microbial diagnosis of
orthopedic infections. Int J of Infect Dis 2009;13(4):
421-4.
Page 2