Streptococcal Serology in Acute Rheumatic Fever Patients: Findings From 2 High-income, High-burden Settings

Susan Jack, Nicole J. Moreland, Jess Meagher, Marea Fittock, Yvonne Galloway, Anna P. Ralph

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Abstract

BACKGROUND: Globally, there is wide variation in streptococcal titer upper limits of normal (ULN) for antistreptolysin O (ASO) and anti-deoxyribonuclease B (ADB) used as an evidence of recent group A streptococcal infection to diagnose acute rheumatic fever (ARF).

METHODS: We audited ASO and ADB titers among individuals with ARF in New Zealand (NZ) and in Australia's Northern Territory. We summarized streptococcal titers by different ARF clinical manifestations, assessed application of locally recommended serology guidelines where NZ uses high ULN cut-offs and calculated the proportion of cases fulfilling alternative serologic diagnostic criteria.

RESULTS: From January 2013 to December 2015, group A streptococcal serology results were available for 350 patients diagnosed with ARF in NZ and 182 patients in Northern Territory. Median peak streptococcal titers were similar in both settings. Among NZ cases, 267/350 (76.3%) met NZ serologic diagnostic criteria, whereas 329/350 (94.0%) met Australian criteria. By applying Australian ULN titer cut-off criteria to NZ cases, excluding chorea, ARF definite cases would increase by 17.6% representing 47 cases.

CONCLUSIONS: ASO and ADB values were similar in these settings. Use of high ULN cut-offs potentially undercounts definite and probable ARF diagnoses. We recommend NZ and other high-burden settings to use globally accepted, age-specific, lower serologic cut-offs to avoid misclassification of ARF.

LanguageEnglish
Pagese1-e6
Number of pages6
JournalThe Pediatric Infectious Disease Journal
Volume38
Issue number1
DOIs
Publication statusPublished - 1 Jan 2019

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Rheumatic Fever
Serology
New Zealand
Antistreptolysin
Northern Territory
Chorea
Streptococcal Infections
Guidelines
deoxyribonuclease B

Cite this

Jack, Susan ; Moreland, Nicole J. ; Meagher, Jess ; Fittock, Marea ; Galloway, Yvonne ; Ralph, Anna P. / Streptococcal Serology in Acute Rheumatic Fever Patients : Findings From 2 High-income, High-burden Settings. In: The Pediatric Infectious Disease Journal. 2019 ; Vol. 38, No. 1. pp. e1-e6.
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abstract = "BACKGROUND: Globally, there is wide variation in streptococcal titer upper limits of normal (ULN) for antistreptolysin O (ASO) and anti-deoxyribonuclease B (ADB) used as an evidence of recent group A streptococcal infection to diagnose acute rheumatic fever (ARF). METHODS: We audited ASO and ADB titers among individuals with ARF in New Zealand (NZ) and in Australia's Northern Territory. We summarized streptococcal titers by different ARF clinical manifestations, assessed application of locally recommended serology guidelines where NZ uses high ULN cut-offs and calculated the proportion of cases fulfilling alternative serologic diagnostic criteria. RESULTS: From January 2013 to December 2015, group A streptococcal serology results were available for 350 patients diagnosed with ARF in NZ and 182 patients in Northern Territory. Median peak streptococcal titers were similar in both settings. Among NZ cases, 267/350 (76.3{\%}) met NZ serologic diagnostic criteria, whereas 329/350 (94.0{\%}) met Australian criteria. By applying Australian ULN titer cut-off criteria to NZ cases, excluding chorea, ARF definite cases would increase by 17.6{\%} representing 47 cases. CONCLUSIONS: ASO and ADB values were similar in these settings. Use of high ULN cut-offs potentially undercounts definite and probable ARF diagnoses. We recommend NZ and other high-burden settings to use globally accepted, age-specific, lower serologic cut-offs to avoid misclassification of ARF.",
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Streptococcal Serology in Acute Rheumatic Fever Patients : Findings From 2 High-income, High-burden Settings. / Jack, Susan; Moreland, Nicole J.; Meagher, Jess; Fittock, Marea; Galloway, Yvonne; Ralph, Anna P.

In: The Pediatric Infectious Disease Journal, Vol. 38, No. 1, 01.01.2019, p. e1-e6.

Research output: Contribution to journalArticleResearchpeer-review

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