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

    Research output: Contribution to journalArticleResearchpeer-review

    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.

    Original languageEnglish
    Pages (from-to)e1-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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    title = "Streptococcal Serology in Acute Rheumatic Fever Patients: Findings From 2 High-income, High-burden Settings",
    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.",
    author = "Susan Jack and Moreland, {Nicole J.} and Jess Meagher and Marea Fittock and Yvonne Galloway and Ralph, {Anna P.}",
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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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    T1 - Streptococcal Serology in Acute Rheumatic Fever Patients

    T2 - Findings From 2 High-income, High-burden Settings

    AU - Jack, Susan

    AU - Moreland, Nicole J.

    AU - Meagher, Jess

    AU - Fittock, Marea

    AU - Galloway, Yvonne

    AU - Ralph, Anna P.

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