Antistreptolysin O titer and C-reactive protein levels in pediatric patients of acute rheumatic fever.

Abstract

<jats:p>Objectives: To determine serum levels of antistreptolysin O titre (ASOT) and C-reactive protein (CRP) and their association with clinical manifestations of Acute rheumatic fever (ARF). Study Design: Descriptive study. Setting: Department of Diagnostic Immunology and Serology, Children’s Hospital and Institute of Child Health, Lahore. Period: Jan 2015 to Jan 2016. Material &amp; Methods: Fifty clinically confirmed patients of ARF were included in this descriptive study. The samples were taken from Children hospital and Institute of child health Lahore after written informed consent. The sampling technique was convenient sampling. Results: Out of 50 enrolled patients, males were 32(64%) and women 18(36%). Only 5(10%) patients had normal ASOT levels, 20(40%) patients were with borderline ASOT, and 25(50%) patients had titres above 200 IU/ml. There was no significant association of ASOT with gender, age and arthralgia with p-value = 0.060, 0.875 and 0.473, respectively. However, a significant association was found in ASOT with carditis and C-reactive protein (p-value = 0.028 and 0.014, respectively). Only 3 (6%) patients had CRP levels below 6mg/l, whereas 43 (86%) patients were with CRP levels above 6. Only 4(8%) patients had borderline value of CRP titer. There was no significant association between C-reactive protein with gender, age and arthralgia (p-value = 0.148, 0.184 and 0.574, respectively). Moreover, there was a significant association between C-reactive protein with carditis and AOST (p-value = 0.020 and 0.014, respectively). Conclusion: ASOT and CRP are important laboratory parameters reflecting undergoing infection (mainly caused by Streptococcus pyogenes A) and inflammation in patients of ARF. Rising levels of ASOT and CRP in ARF patients might be used as an indicator of involvement of heart tissues and therefore can be used to monitor transition of rheumatic carditis into Rheumatic heart disease.</jats:p>

Utility of Human Immune Responses to GAS Antigens as a Diagnostic Indicator for ARF: A Systematic Review

“…Seven of the studies classed as of high risk of bias (NOS <5) were completed before 1990 with authors failing to clearly define the controls or cases with appropriate diagnostic guidelines ( 33 – 35 , 37 , 39 , 43 , 52 ). One study Zainab et al ( 53 ) recruited no controls but instead used an ULN cut-off published previously from within the same region.…”

“…In a subgroup analysis according to whether a guideline for the diagnosis of ARF was used or not, the association was not found to be statistically significant among studies not utilizing a guideline. Amongst studies not included in the meta-analysis due to the absence of a control group, each report a rise in anti-SLO titer: Zainab ( 53 ) in 24 of 50 cases (48%) of ARF diagnosed according to the Jones criteria (published standard = 200 IU/ml), Saini ( 48 ) in 15 of 26 (58%) cases of ARF as per the Jones criteria guideline (published standard = 262 IU/ml), Hokonohara ( 39 ) in 24 of 67 cases of ARF (36%) against published standard = 240 IU/ml.…”