Evaluate the effectiveness of tonsillectomy and long-acting penicillin on the levels of the antistreptolysin O titer in children with recurrent tonsillitis

Background: Tonsillitis is widespread among children and has serious poststreptococcal complications, and both the patients and clinician have to face the question on what is the role and benefit of using long-acting penicillin and whether it is an alternative method of treatment to surgery?. This study was carried out to evaluate the effectiveness of tonsillectomy compared with long-acting penicillin in the treatment of recurrent tonsillitis, comparing their effects on the levels of the antistreptolysin O titer (ASOT).Methods: A total of 100 patients aged 4-15 years with recurrent tonsillitis and signs of chronic tonsillitis, after exclusion of patients with bleeding diathesis, anemia, chronic illness, and criteria of rheumatic fever, were included in this study, they were divided to two groups comprising 50 patients each. The first group was treated by tonsillectomy, whereas the second group was treated using long-acting penicillin monthly for 6 months. They were clinically evaluated, ASOT levels were recorded for all patients before management and after 6 months.Results: The mean ASOT readings before management and after 6 months for the tonsillectomy group were 518.29 and 117.13 IU/ml, respectively (P value <0.004), whereas for the penicillin group, they were 526.70 and 262.98 IU/ml, respectively (P value <0.072).Conclusions: This study demonstrates that the first line of treatment of recurrent chronic tonsillitis is tonsillectomy, as it is both clinically effective and cost-effective for children and that the second line of treatment is long-acting penicillin with a long-term follow-up and in patients have contraindications for surgery such as bleeding diathesis.

Progress of the relationship between Streptococcus infection and Henoch-Sch?nlein purpura,purpura ne-phritis / 国际儿科学杂志

Group A streptococcus ( GAS) is the most common pathogens of human streptococcal infec-tion. It is considered that GAS infection is one of the important factors leading to Henoch-Sch?nlein purpura (HSP). It can promote the occurrence of Henoch-Sch?nlein purpura nephritis(HSPN),and aggravate HSPN. Hemolysin,protease and superantigen involved in the pathogenesis of GAS. Research progress of the relationship between streptococcal infection and HSP and HSPN are summarized as follows.

Diagnosis and treatment of group A β-hemolytic Streptococcal pharyngitis / 中华实用儿科临床杂志

Group A β-hemolytic Streptococcus(GAS) can cause a variety of infectious diseases,acute pharyngitis,and impetigo are the most.Non-suppurative complications can be followed after GAS infections,such as acute rheumatic fever,acute glomerulonephritis.GAS pharyngitis has no specific differences with other pathogens.Throat culture or rapid antigen detection test(RADT) should be done to determine whether GAS infections.Children with acute GAS pharyngitis should receive antibiotic therapy.Penicillin is the recommended antimicrobial agent.

Títulos de antiestreptolisina O en escolares del estado Aragua, Venezuela / Antistreptolysin О in school children at Aragua State, Venezuela

La antiestreptolisina O (ASO), es empleada como método diagnóstico de infecciones por estreptococos beta hemolíticos del grupo A (EBHGA). Esta bacteria produce faringitis y amigdalitis, y puede conllevar a secuelas como la fiebre reumática y la glomerulonefritis, que pueden ser prevenidas con un diagnóstico y tratamiento oportuno. A 125 niños sanos con edades entre 6 y 9 años, del municipio Francisco Linares Alcántara, se les realizó el cultivo de exudado faríngeo y la determinación de títulos de ASO. De ellos ninguno fue portador asintomático de EBHGA, sin embargo se aisló 0,8% de estreptococos beta hemolítico del grupo C y 0,8% de estreptococos beta hemolíticos del grupo F. Por otro lado, el 88,8% de los niños presentó títulos menores de 166 Unidades Todd/mL y el 10,4% un título de 333 Unidades Todd/mL, estableciéndose este último como posible valor referencial para la población en estudio, el cual difiere del señalado por los equipos diagnósticos utilizados en el país, que son obtenidos en otros países y con muestras de adultos. Esto apoya el hecho de que se deben establecer valores referenciales para cada población, de manera que se pueda realizar un diagnóstico asertivo y precoz para evitar las posibles secuelas postestreptocócicas.

Antistreptolysin О (ASO) is used as a diagnostic method for group A beta-hemolytic streptococci (GABHS) infections. This bacterium produces pharyngitis and tonsillitis and can lead to rheumatic fever and glomerulonephritis sequelae, which can be prevented by opportune diagnosis and treatment. A group of 125 healthy children with ages between 6 and 9 years from the Francisco Linares Alcántara municipality, were tested by carrying out a throat culture and determination of ASO titers. None of them were asymptomatic GABHS carriers, nevertheless, 0.8% group C beta-hemolytic streptococci, and 0.8% group F beta-hemolytic streptococci were isolated. On the other hand, 88.8% of children presented titers under 166 Todd Units/mL and 10.4% a titers of 333 Todd Units/mL, establishing this last one as possible reference value for the study population, which differs from those of diagnostic equipments used in the country, which have values obtained from other countries and with samples from adult specimens. This supports the fact that reference values should be established for each population, so that an assertive and early diagnosis can be done, avoiding possible post-streptococci sequelae.

Encefalopatía hipertensiva secundaria a glomerulonefritis aguda postestreptocócica / Hypertensive encephalopathy due to acute post-streptococcal glomerulonephritis

Introducción. La glomerulonefritis aguda postestreptocócica (GNA-PE) es la causa más frecuente del síndrome nefrítico en la niñez; tiene un amplio espectro de presentación que va desde una condición asintomática hasta condiciones graves como: falla renal aguda y encefalopatía. La incidencia ha disminuido en los últimos años, aunque deficientes condiciones higiénicas pueden aumentar la prevalencia de infecciones estreptocócicas nefritogénicas, y con ello aumentar el riesgo de brotes epidémicos de glomerulonefritis aguda. La encefalopatía hipertensiva (EH) se presenta en 1 a 7% de los casos durante el curso de la enfermedad y es una complicación grave, pero que manejada adecuadamente no deja secuelas. En el diagnóstico diferencial se deben tener en cuenta eventos vasculares cerebrales, infecciones del sistema nervioso central, tumores cerebrales y alteraciones tóxico-metabólicas. Caso clínico. Se describe el caso de un escolar masculino de 10 años de edad, previamente sano, con antecedente de faringoamigdalitis en la semana previa a su atención en urgencias. Fue llevado a consulta por alteración del sensorio; cursó con un estado convulsivo parcial que cedió al aplicar diacepam endovenoso. Se detectó hipertensión arterial, hematuria y edema pretibial discreto; la tomografía axial computada de cerebro no mostró edema, lesión ocupante de espacio o hemorragia. Los resultados de laboratorio mostraron bioquímica sanguínea normal y antiestreptolisina O elevada. Se manejó el caso como una GNAPE con evolución favorable. Conclusión. El diagnóstico de GNAPE se debe sospechar en niños con historia de infección de vías respiratorias superiores que se presentan con encefalopatía hipertensiva súbita.

Introduction. Acute post-streptococcal glomerulonephritis (APS-GN) is the leading cause of nephritic syndrome in children and has a broad spectrum of clinical presentation ranging from asymptomatic cases to acute renal failure and encephalopathy. Most cases are sporadic although the disease may occur in epidemic form, mainly related to poor sanitary conditions. Hypertensive encephalopathy is a severe complication, but there is a good outcome with appropriate treatment. Case report. We describe the case of a previously healthy 10-year-old male with a history of pharyngitis 1 week before his arrival to the emergency room. He presented with altered consciousness, partial seizures, hypertension and hematuria. Cranial computed tomography was performed and showed no edema, mass or hemorrhage; antistreptolysin O serum titers were elevated. He was treated according to hypertensive encephalopathy due to APSGN, with a favorable outcome. Differential diagnosis should include cerebral vascular diseases, intracranial tumors, central nervous system infections and toxic metabolic disturb ances. Conclusion. APSGN should be suspected in any child with history of pharyngitis and sudden onset of hypertensive encephalopathy.

Normal antistreptolysin O titers of children by age group in the Gyeonggi-Incheon region / 소아과

PURPOSE: Measurement of antistreptolysin O (ASO) is often necessary to confirm a clinical diagnosis of recent streptococcal infection, especially in patients suspected of rheumatic fever and acute glomerulonephritis. Standard normal ranges for ASO should be established locally for each age group. We analyzed ASO to determine the upper limit of normal (ULN) ASO in children in the Gyeonggi-Incheon area. METHODS: ASO in normal individual concentrations were measured quantitatively by nephelometry on sera from 753 children (Male:381, Female:372). ULN were determined by separating the upper 20% from the lower 80% of the group (80 percentile). RESULTS: The mean ASO concentration calculated in a total cases was 149.9+/-7.2 IU/mL. The ASO concentration in neonates was 83.4+/-10.7 IU/mL, and lowest in the 1 year of age group, 26.7+/-6.6 IU/ mL, and increased to 318.0+/-33.2 IU/mL gradually in the 9 years of age group. Thereafter, ASO concentration decreased. The ULN for neonates was 122 IU/mL, for 0-3 years, 40 IU/mL; for 4-6 years, 113 IU/ mL; for 7-9 years, 489 IU/mL; for 10-19 years, 433 IU/mL; for 20-29 years, 122 IU/mL. CONCLUSION: The age-specific ULN for children in the Gyeonggi-Incheon area were determined. The distribution of ASO concentration according to age groups was different from previous reports. These results should be of clinical value to physicians to interprete the ASO results of their patients.

The findings in a survey of antistreptolysin O (ASLO) in rural children at some schools in Tay Nguyen area

ASLO is an antibody to streptolysin O. Streptolysin O is a hemolysin that produced by group A beta-hemolytic Streptococcus. Streptococcus can cause upper respiratory tract infection, acute glomerulonephritis and rheumatic fever. The rate of ASLO occurrence is 35.22%, in which 12.61% have pathological value with average titer of ASLO is 172.41 Todd. The children under 10 years old have ASLO occurrence rate higher than children over 10 years old. There was not difference between males and females. The rate of group A beta-type Streptococcus isolation is 21.30%.

Serum protein and immunoglobulin levels among nepalese living in southern Nepal

<p><b>OBJECTIVE</b>This study examined the levels of serum protein fractionation, immunoglobulin (Ig) and antistreptolysin O (ASO) of people (91 males and 84 females aged 10-68 years) living in the Terai region of southern Nepal, as there has previously been no information available about them.</p><p><b>METHODS</b>Blood samples were collected early in the morning after overnight fasting. Serum protein fractionation was carried out by cellulose-acetate electrophoresis. IgG, IgA, IgM and ASO were measured by immuno-turbidimetry with clinical kits.</p><p><b>RESULTS</b>The mean proportion of albumin (Alb) was rather low due to increased globulin (Glb). The Alb level of males was significantly higher than that of females, while the male γ-Glb level was significantly lower than that of females. The mean values of IgG, IgM and ASO for males were lower than those values for females, although the difference was significant only for the IgM value. The mean values of IgM for female age groups of 30-39 years or less were significantly higher than those for the corresponding male age groups. Age correlated positively with IgA, and negatively with ASO in both sexes. γ-Glb and IgG correlated significantly with TP, AlB, α(1)-Glb and IgA in both sexes. ASO correlated with β-Glb and IgA in males, and with γ-Glb and IgG in females.</p><p><b>CONCLUSIONS</b>The fact that the level of γ-Glb, a major component of serum globulin, was high suggested exposure to a highly bacterial and viral environment. These results point to the need to prevent infectious diseases as well as improve their nutritional status, especially for children and young adults.</p>

Serum Protein and Immunoglobulin Levels among Nepalese Living in Southern Nepal

Objective: This study examined the levels of serum protein fractionation, immunoglobulin (Ig) and antistreptolysin O (ASO) of people (91 males and 84 females aged 10−68 years) living in the Terai region of southern Nepal, as there had previously been no information available about them. Methods: Blood samples were collected early in the morning after overnight fasting. Serum protein fractionation was carried out by cellulose-acetate electrophoresis. IgG, IgA, IgM and ASO were measured by immuno-turbidimetry with clinical kits. Results: The mean proportion of albumin (Alb) was rather low due to increased globulin (Glb). The Alb level of males was significantly higher than that of females, while the male γ-Glb level was significantly lower than that of females. The mean values of IgG, IgM and ASO for males were lower than those values for females, although the difference was significant only for the IgM value. The mean values of IgM for female age groups of 30-39 years or less were significantly higher than those for the corresponding male age groups. Age correlated positively with IgA, and negatively with ASO in both sexes. γ-Glb and IgG correlated significantly with TP, Alb, α1-Glb and IgA in both sexes. ASO correlated with β-Glb and IgA in males, and with γ-Glb and IgG in females. Conclusions: The fact that the level of γ-Glb, a major component of serum globulin, was high suggested exposure to a highly bacterial and viral environment. These results point to the need to prevent infectious diseases as well as improve their nutritional status, especially for children and young adults.

Distribution and Upper Limit of Normal Antistreptolysin O Concentrations of School / 감염

BACKGROUND: Antistreptolysin O (ASO) is very useful as an indicator of recent streptococcal infections and their sequelae, such as rheumatic fever and acute glomerulonephritis. To interpret single ASO level of patients, the upper limit of normal (ULN) ASO from the same age group in the area should be known. As Streptococcus pyogenes infections are quite common in elementary school, we measured ASO and analyzed them by the results of throat culture to determine upper limit of normal ASO of school children in Chinju area. METHODS: ASO concentrations were measured quantitatively by nephelometry on 436 sera of healthy elementary school children in Chinju area. Throat cultures were taken at the same time to evaluate the relationship between ASO concentrations and throat culture results, including serogroup, colony forming units (CFU), and M types. RESULTS: The mean ASO concentration was 285IU/ml and the upper limit of normal ASO was 433IU/ml. The ASO levels were even (253-285IU/ml) through whole school grades except the 5th grade (350IU/ml). Not only the carriers of group A streptococci, but also those of group C or group G streptococci had higher ASO levels. The children from whom more than 10 CFU of S. pyogenes were isolated showed higher ASO levels than those who had less than 10 CFU. The ASO levels were higher in M type 6 or 22 compared to M type 12 or 28. CONCLUSIONS: The upper limit of normal ASO of children in Chinju was 433IU/ml, that is between Seoul(326IU/ml) and Chungnam (499IU/ml). The children who had more than 10 CFU tended to have higher ASO levels, which indicate asymptomatic infections, are associated with burden of bacteria. Group C or group G streptococci may induce serum response like group A streptococci. Certain M types may be implicated as strong producer of streptolysin O.

Relationship between Antistreptolysin O Titer and Number of Colonies from Throat Swab Culture Plate in Group A Beta-hemolytic Streptococcal Carriers and Normal School Children

PURPOSE: To know the true carrier rate and the immunologic responses (antistreptolysin O :ASO) to beta-hemolytic streptococci which obtained from normal school children with or without carrying streptococci. And to study the clinical meaning of the number of organisms found in culture. METHODS: One hundred ninty-eight first grade of elementary school children were included. I obtained throat swab culture from tonsil and tonsilar fossa with sterile cotton ball stick and plated on sheep blood agar dish, counted number of colonies of beta-hemolytic streptococci (BHS) after overnight incubation, examined ASO titer (Rantz-Randall method) simultaneously, and differentiated grouping of BHS with Streptex. RESULTS: 1) Of the 198 normal school children, 34 (17.2%) had cultured BHS. 16 (8.1%) were group A, 4 (2.0%) were group C, 2 (1.0%) were group G, and 12 (6.1%) were non-grouping BHS. 2) 14 (22.2%) out of 63 normal children without carrying BHS and 16 (47.1%) out of 34 with carrying BHS had come out above 250 units of ASO. 13 (59.1%) out of 22 group A,C,G streptococcal carriers had showed above 250 units of ASO. The true carrier rate of BHS were 18 (9.0%) out of 198 elementary school children. 3) When I had counted the number of colonies from 34 carrier of BHS, 1+ was 67.6% and 2+ was 17.6%. It was 85.2% of total children with carrier. 4) There were significant differences between the mean titer of logarithmic ASO obtained from group A BHS carrier and that of normal children without carrying BHS (P=0.001), and differences between that of group A and group B,C,G streptococci (P= 0.0005). CONCLUSIONS: The ASO titer obtained from BHS carrier is higher than normal school children, which suggests the possibility of subclinical infection, the possibility of persistent habor of organism since past infection had contracted, and the possibility of replaced old organism in past infection with new organism. It should be performed follow-up study for identifying the persistence of immunologic response in accordance with or without culturing organism.

The Correlation between a Semi-quantitative ASO (Antistreptolysin O) Assay by Rantz-Randall and a Quantitative ASO Assay by Nephelometry

PURPOSE: Accurate diagnosis and prompt treatment of infection with Streptococcus pyogenes (group A streptococci) is required as it may cause many complications, and chronic serious sequelae, acute rheumatic fever and acute glomerulonephritis. Recently, the assay methods of ASO concentration tend to be changed into quantitatively from semi-quantitative or qualitative methods in this country. We would like to know relationships and degree of concurrences between two methods. METHODS: Total eighty-three elementary school children, aged from 7 to 8, were involved for this study. They had been examined throat swab culture with conventional methods and letting down the blood for measuring ASO titer simultaneously. We examined ASO titer by both Rantz-Randall method and Nephelometry. RESULTS: The correlation between a semi-quantitative ASO assay by Rantz-Randall (X) and a quantitative ASO assay by Nephelometry (Y) was Y=1.69X+76.7 (r=0.81). Compared to the Nephelometry test, Rantz-Randall test showed a sensitivity of 72.7% and specificity of 100%. Accordingly, the concordance rate of two methods was 89.2%. CONCLUSIONS: There seems to be high correlation and concordance rate between Rantz-Randall and Nephelometry. It needs to be changed methods for ASO titer measurement from semi-quantitative to quantitative methods for reducing possible laboratory error and for reliable standardization. Altogether, interpretation of ASO titer should be on the ASO value of different geographic areas, in different seasons, and year by year.

The Correlation between a Semi-quantitative ASO (Antistreptolysin O) Assay by Rantz-Randall and a Quantitative ASO Assay by Nephelometry

PURPOSE: Accurate diagnosis and prompt treatment of infection with Streptococcus pyogenes (group A streptococci) is required as it may cause many complications, and chronic serious sequelae, acute rheumatic fever and acute glomerulonephritis. Recently, the assay methods of ASO concentration tend to be changed into quantitatively from semi-quantitative or qualitative methods in this country. We would like to know relationships and degree of concurrences between two methods. METHODS: Total eighty-three elementary school children, aged from 7 to 8, were involved for this study. They had been examined throat swab culture with conventional methods and letting down the blood for measuring ASO titer simultaneously. We examined ASO titer by both Rantz-Randall method and Nephelometry. RESULTS: The correlation between a semi-quantitative ASO assay by Rantz-Randall (X) and a quantitative ASO assay by Nephelometry (Y) was Y=1.69X+76.7 (r=0.81). Compared to the Nephelometry test, Rantz-Randall test showed a sensitivity of 72.7% and specificity of 100%. Accordingly, the concordance rate of two methods was 89.2%. CONCLUSIONS: There seems to be high correlation and concordance rate between Rantz-Randall and Nephelometry. It needs to be changed methods for ASO titer measurement from semi-quantitative to quantitative methods for reducing possible laboratory error and for reliable standardization. Altogether, interpretation of ASO titer should be on the ASO value of different geographic areas, in different seasons, and year by year.

Antistreptolysin O titers in school age children and in adults.

A study of ASO titers by latex agglutination was carried out in 176 healthy. Thais were ranging in age from 6 to 59 years. The peak ASO titer was reached with subjects of 11-15 years of age. Titer at 6-10 years of age was also high but slightly lower than that at 11-15 years. The level gradually decreased from age 16 to 59 years. In this study, 72.16% of all ASO titers were below 200 IU/ml, 20.45% were between 200-400 IU/ml, the remainders, 7.39%, were equal to or above 400 IU/ml. An upper limit of no more than 400 IU/ml. can be given to the group of 6-35 years of age. Above 35, the upper limit is not more than 200 IU/ml. However, latex ASO test is good for screening because it is simple and rapid. Semiquantitative titers can also be determined by serial dilution of the serum. Confirmation of the elevated latex ASO titers can be done by a haemolytic test.