Streptococcal Serology in Acute Rheumatic Fever Patients: Findings From 2 High-income, High-burden Settings.
Pediatr Infect Dis J
; 38(1): e1-e6, 2019 01.
Article
en En
| MEDLINE
| ID: mdl-30256313
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.
Texto completo:
1
Colección:
01-internacional
Base de datos:
MEDLINE
Asunto principal:
Fiebre Reumática
/
Factores Socioeconómicos
/
Infecciones Estreptocócicas
/
Costo de Enfermedad
/
Anticuerpos Antibacterianos
Tipo de estudio:
Diagnostic_studies
/
Guideline
/
Observational_studies
/
Risk_factors_studies
Aspecto:
Determinantes_sociais_saude
Límite:
Adolescent
/
Child
/
Female
/
Humans
/
Male
País/Región como asunto:
Oceania
Idioma:
En
Revista:
Pediatr Infect Dis J
Asunto de la revista:
DOENCAS TRANSMISSIVEIS
/
PEDIATRIA
Año:
2019
Tipo del documento:
Article
País de afiliación:
Nueva Zelanda