Antistreptolysin Research Articles

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

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 & 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.

Cross-sectional study of population-specific streptococcal antibody titres in Uganda.

Despite substantial variation of streptococcal antibody titres among global populations, there is no data on normal values in sub-Saharan Africa. The objective of this study was to establish normal values for antistreptolysin O (ASO) and antideoxyribonuclease B (ADB) antibodies in Uganda. This was an observational cross-sectional study. This study was conducted at Mulago National Referral Hospital, which is located in the capital city, Kampala, and includes the Uganda Heart Institute. Participants (aged 0-50 years) were recruited. Of 428 participants, 22 were excluded from analysis, and 183 (44.4%) of the remaining were children aged 5-15 years. ASO was measured in-country by nephelometric technique. ADB samples were sent to Australia (PathWest) for analysis by enzyme inhibition assay: 80% upper limit values were established. The median ASO titre in this age group was 220 IU/mL, with the 80th percentile value of 389 IU/mL. The median ADB titre in this age group was 375 IU/mL, with the 80th percentile value of 568 IU/mL. The estimated Ugandan paediatric population standardised 80% upper-limit-of-normal ASO and ADB titres is higher than many global populations. Appropriateness of using population-specific antibody cutoffs is yet to be determined and has important implications for the sensitivity and specificity of rheumatic fever diagnosis.

Assessment of Anti-Streptolysin O Titre in Healthy School Age Children in El Behira Governorate

Background: Group-A streptococcal serology is used for post-streptococcal disease diagnoses, such as acute rheumatic fever, and occasionally for diagnosis of streptococcal pharyngitis. The prevalence of rheumatic fever in school children aged 6 to 15 years ranges between 0.2 to 0.75 per 1000 children per year. The prevalence of rheumatic heart disease in 1000 children ranges from 1 to 5.4. Aim of the work: To determine upper limit of the normal range of Antistreptolysin O titre in healthy school children, aged 6-15 years old in El Behira governorate. Patients and Methods:A cross-sectional study had been performed in EL Behira Governorate and the collected sample were tested in clinical pathology Lab [Al-Azhar University Hospital, Damietta]. A total of 3000 [1609 Males, 1391 Females] serum samples had been collected from children aged 6-15 years, had been tested for Anti-streptolysin O titer [ASO] by turbidimetry. Results: Normal value for the ASO titer rose sharply during early childhood and then declined gradually with age. The estimated titer that was 80% of the upper limit or normal at age 10 years was 287 IU/ml for ASO. Conclusion: This study provides the upper limit of normal value for ASO titre of school children. The more than 400 rating should instruct clinicians in the treatment of post-streptococcal diseases in patients and provide valuable longitudinal evidence for potential intervention trials against streptococcal diseases in group A.

New-Onset of Crohn's Disease Is Associated with Antistreptolysin O Positive Titers.

ObjectiveDifferent infectious agents have been presumed to be candidates acting as an etiologic factor or trigger of Crohn’s disease (CD). Group A Streptococcus (GAS) is a common human infection agent that can also trigger post-infectious immune-mediated conditions. The current study aimed to examine whether the immunogenic activity induced by GAS may trigger new-onset of CD.MethodsData for antistreptolysin O (ASO) level, throat culture for GAS, and history of streptococcal infection were collected from 91 patients with CD that were divided into three groups including; new-onset CD, CD in remission and active CD. The data were compared with the control group.ResultsAll participants had negative results of throat culture for GAS and had no history of documented streptococcal infection in the past year. Our results indicate that new-onset CD, but not CD in remission or active CD, is associated with significantly increased positive ASO compared to controls. Half of the patients in the new-onset CD group were ASO positive, which was significantly higher compared to the control group in a univariant (OR: 4.00; 95% CI 1.27–12.58; P=0.02) and multivariant analysis (OR: 4.41; 95% CI 1.35–14.37; P=0.014).ConclusionOur study is the first to focus on ASO levels in patients with CD and to demonstrate a significant association between ASO and new-onset of CD. Large prospective randomized controlled studies are needed to confirm the validity of this data and to further clarify the clinical significance of our findings.

P133 Chronic recurrent multifocal osteomyelitis (CRMO) associated with polymyositis and polyarthritis in a boy

Abstract Background CRMO is an autoinflammatory bone disease mainly affecting the paediatric age group. It may have overlapping features with other rheumatological diseases. I report a case of a 7-year-old boy who presented with fever, persistent limp and pain at multiple sites involving the extremities. Methods His complaint started with pain in the gluteal region with an accompanying limp. Two months later, he started having fever, pain and localised swelling around multiple sites - right knee, right ankle and left wrist associated with intermittent night pain and morning stiffness. MSK examination revealed localised peri-articular swelling and restriction of movements involving bilateral knees, ankles, hips and wrists. Lab reports showed low hemoglobin, neutrophilic leucocytosis, elevated platelets, CRP and ESR. Muscle enzymes (CPK, SGPT, SGOT, LDH), bone profile, ferritin, RF, ASO titer, ANA and ANA profile were normal. Whole body MRI (WBM) revealed multifocal bone marrow edema predominantly in metaphyseal regions involving multiple bones. Polymyositis and mild effusions were noted in bilateral hips and knees. He was put on oral naproxen, prednisolone, methotrexate and pamindronate infusion for two days. He responded dramatically and continues to remain well at two weeks' follow up. Results CRMO is mainly associated with severe acne, palmoplantar pustulosis, generalised pustular psoriasis, pyoderma gangrenosum, ankylosing spondylitis and inflammatory bowel disease. There are only 2-3 reported cases of CRMO associated myositis in adolescents to the best of my knowledge. This child will be the youngest diagnosed CRMO with polymyositis. Conclusion When any child presents with fever, recurrent or chronic night pain and/or swelling at multiple sites with moderate elevation of inflammatory markers, we should suspect CRMO and our first choice of investigation should be whole body MRI to reveal associated extra-osseous lesions. Disclosures D.B. Pandya None.

EP13 A standard case of reactive arthritis? Plot twist!

Abstract Background A 49 year old male patient presented to the acute medical unit with history of acute onset high grade fever with polyarthritis involving right knee, left elbow, both ankles and small joints of right hand preceded by 2 days of diarrhoea and vomiting. He had temperature of 38°C, BP: 156/77 mmHg, Pulse rate: 98/min. Initial blood tests: CRP: 312, ESR: 51, and leucocytosis (WBC count: 17.9 with neutrophilia: 13.1). The medical team considered diagnosis of multifocal septic arthritis and initiated IV flucloxacillin empirically. He had past medical history of recently treated extra pulmonary tuberculosis three months prior to admission. Methods CT thorax abdomen and pelvis scan was organised to rule out reactivation of tuberculosis/Poncet’s arthritis. CT revealed generalised lymphadenopathy and bilateral hip effusions. At this point, a Rheumatology opinion was requested, a synovial fluid aspiration from the right knee, the most affected joint, was performed. The turbid sample had numerous pus cells, but negative gram stain and negative cultures after prolonged culture. AFB stain was negative. He was improving systemically but had intermittent fevers and CRP remained high (155mg/l). Synovial fluid sample was sent for 16S PCR testing and Streptococcus pyogenes ribosomal DNA was detected. Testing for serum ASO titres revealed elevated titres (32000 IU/mL). In conjunction with microbiology team, we augmented antibiotics to IV Gentamicin and IV Ceftriaxone. A careful history revealed transient throat infection of 6 hours duration 10 days prior to onset of arthritis. Urinary dipstick and ACR revealed proteinuria (ACR 84.8). This is under close follow-up with renal team who feel that post Streptococcal Glomerular Nephritis is likely but deferred renal biopsy. 2 DECHO study ruled out valve abnormality. A right inguinal lymph node biopsy was attempted; however, tissue sample was unsuitable. Hepatitis screen was negative and Antibody panel (ANA, ANCA were negative, RF: borderline positive (26) were unremarkable. He received total duration of 31 days of antibiotics. CRP eventually improved to 13, on follow up, in view of persisting arthritis, orals steroids (15mg OD) was prescribed for three weeks. Results Thus, we achieved a compelling diagnosis of acute rheumatic fever, with possible focus in the throat and probably bacteraemic spread to the right knee. PCR analysis of synovial fluid in context of negative culture guided antibiotic therapy choice, duration and cautious approach for immunosuppression. The patient’s story evolved with development of proteinuria suggestive of possible post streptococcal glomerulonephritis which is under follow up. Conclusion Rheumatologists are faced with challenge of reviewing ill patients with joint effusions in whom empirical antibiotics have been started. In this scenario, joint aspiration yields lower positive culture results. 16S PCR analysis can help in guiding antibiotic choice and duration with negative culture. Disclosures A. Desai None. E. Justice None. M. Rahman None. A. Johnson None.

Elevated antistreptolysin O titer is closely related to cardiac mitral insufficiency in untreated patients with Takayasu arteritis

BackgroundThe etiology of Takayasu arteritis (TA) is unknown; however, a possible relationship between streptococcal infection and TA has been proposed. This study aimed to identify the clinical features and cardiac valvular involvement in untreated TA patients with an elevated antistreptolysin O (ASO) titer.MethodsIn this retrospective study, the clinical characteristics and features of valvular involvement were compared in TA patients with or without an elevated ASO titer.ResultsOf the 74 untreated TA patients, 13 patients were found have elevated ASO titers (17.6%). Mitral insufficiency was the most common in patients with elevated ASO (69.2%, 9/13), followed by aortic valve insufficiency (46.2%, 5/13) and tricuspid insufficiency (46.2%, 5/13), which were no significantly different than that in normal ASO group. The proportions of moderate to severe mitral (30.8% vs 1.6%, p = 0.000) and tricuspid valve (15.4% vs 1.64%, p = 0.023) insufficiency in the ASO positive group were significantly higher than those in the ASO negative group. The odds of mitral regurgitation in patients with elevated ASO titers were 3.9 times higher than those in the group with normal ASO titers (p = 0.053, OR = 3.929, 95% confidence interval [CI]: 0.983–15.694). Furthermore, the risk of moderate to severe mitral insufficiency in patients with elevated ASO titers was 41.6 times higher than that in patients with normal ASO titers (p = 0.002, OR = 41.600, 95% CI: 3.867–447.559).ConclusionsAn increase in ASO titer is related to valvular involvement in TA and is closely linked to mitral insufficiency.

Anti-streptolysin O (ASO) Antibodies are elevated in Patients with First Episode Psychosis and Chronic Schizophrenia compared to controls

Anti-streptolysin O (ASO) Antibodies are elevated in Patients with First Episode Psychosis and Chronic Schizophrenia compared to controls

Pediatric lupus nephritis - An evil cousin of its adult counterpart: A single-center based experience from a tertiary care hospital of Eastern India.

Systemic lupus erythematosus is an autoimmune multisystem disease with a high predilection for renal involvement. Lupus nephritis develops in 20% to 75% within the first two years. Presentation varies from subnephrotic proteinuria to end-stage renal disease. To study clinical features, biochemical, and serological parameters and correlate with histological activity and chronicity score [modified National Institute of Health (NIH) score]. Retrospective, cross-sectional, single-center based study in a tertiary care hospital of Eastern India. We incuded 36 children with lupus nephritis diagnosed from February 2018 to March 2019. Laboratory data included were complete blood count (CBC), blood glucose, urine analysis, serum urea, creatinine, blood urea nitrogen (BUN), albumin, cholesterol, HBsAg, antihepatitis C virus (HCV) antibody, antistreptolysin O (ASO) titer, antinuclear antibody (ANA), myeloperoxidase antineutrophil cytoplasmic antibody (MPO ANCA), proteinase 3 antineutrophil cytoplasmic antibody (PR3 ANCA), double-stranded DNA (dsDNA), C3, and C4. Clinical parameters were age, sex, blood pressure (BP), skin lesions, arthralgia, edema, obesity. Renal biopsies examined with light microscopy, hematoxylin and eosin (H and E), periodic acid-Schiff (PAS), silver methanamine, Masson's trichrome (MT) stains. Immunofluorescence microscopy done with IgG, IgM, IgA, C3c, C1q, kappa, lambda antibodies. Kruskal-Wallis and χ2 tests. Mean age was 15.12 ± 3.49 and 12.5 ± 1.73 years for lupus nephritis (LN) with activity and LN without activity, respectively. Mean dsDNA was higher and mean C3 was lower (52.35 ± 22.21 mg/dl) in active LN. Mean 24-hour urinary protein was higher in LN without activity. Serum creatinine was raised in active LN. LN class III and IV showed higher activity than chronicity. Pediatric LN is proliferative and more active as compared with adult counterparts. Activity scores are much higher than chronicity scores.

A Comparative study to evaluate the effectiveness of Tonsillectomy with Long term Penicillin in the management of recurrent tonsillitis

Introduction: Tonsillitis is widespread among children and has serious poststreptococcal complications, and both the patients and the otolaryngology surgeon 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) and erythrocyte sedimentation rate (ESR). Methods: This study was carried out as a prospective study. A total of 100 Children were chosen for this study. Subjects fulfilling the inclusion criteria like , Age of 5–15 years , Children suffering from recurrent tonsillitis with signs of chronic tonsillitis: inequality in the size of the tonsils, enlarged cervical lymph nodes, and pus in the tonsillar crypts 6 , Severe attacks of tonsillitis: seven times in 1 year or five times in each of 2 years, or three times in each of 3 years & An ASOT of greater than 400 IU/ml and an ESR of greater than 30 ml/1 at 1/2 h 10,11.were selected by simple random sampling method. Results : The frequencies of occurrence of fever, cough, obstructive sleep apnea, unequal tonsil size, and pus in the tonsillar crypts were 80% , 51 % , 4% , 52% , and 48 %, respectively. Effect of tonsillectomy versus the effect of long-acting penicillin on ASOT, we found that the levels after 3 months were lower in patients who were treated by tonsillectomy than in those who were treated with long-acting penicillin; the difference between both the groups was found to be statistically significant. Conclusion: This study presents important insight into the alternate treatment regimens of Recurrent Tonsillitis in rural children. 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 long-term follow-up, and in patients, have contraindications for surgery such as bleeding diathesis.

Novel Pathogenic Genes and Rare Mutations of Congenital Factor V Deficiency: A Case Report

Background: Congenital factor V (FV) deficiency is a rare autosomal recessive bleeding disorder associated with mild to severe bleeding symptoms, with an estimated prevalence of 1/1 000 000 in homozygotes. So far, a total of 56 mutations have been issued, rendering severe or moderately severe FV deficiency; of which, over two-thirds are nonsense mutations (mainly responsible for reducing FV expression), and the rest are missense mutations (which usually impair the secretion of FV). Case Description: We report a 4-year-old female who was admitted for blood coagulation dysfunction for over a month. More than a month ago, she received oral 1/3 tablets of "Compound Aminopyrine Phenacetin Tablets" because of fever and cough, but difficult-to-control epistaxis occurred about 10 minutes later. Blood tests from other hospitals showed that her prothrombin time (PT) and the activated partial thromboplastin time (APTT) values were 62.1 s and 221.6 s, respectively, and determined the blood coagulation factors II, VII, and X to be 63%, 34%, and 68%, respectively. What's more, multiple administrations of human prothrombin complex and vitamin K1 intravenous infusion did not significantly improve her coagulation function. Results of the lupus anticoagulants (LA) primary screening and confirmation test in our hospital were 159.5 s and 102.0 s, respectively, with a ratio of 1.6; blood coagulation factor II, VII, VIII, IX, X, XI, and XII activity were 87.2%, 57.7%, 60.6%, 50.4%, 76.1%, 61.5%, and 33.3%, respectively, while the FV activity (FV:C) level was quite low (1.6%). In addition, no abnormalities were detected in her thyroid function, anti-streptolysin O (ASO), autoimmune antibody markers, T cell subsets, serum immunoglobulin G4 levels, coagulation FV and its inhibitor levels, and humoral immune combinations. Therefore, we first ruled out the possibility of systemic lupus erythematosus. Furthermore, DNA sequence analysis identified a missense point mutation of the FV gene (NM_000130: exon23: c.C6304T: p.R2102C), a pathogenic site suggested by the ClinVar database. Given the characteristics of heterozygotes, we suspected that there was another mutation site, most likely a compound heterozygous mutation, 2 sites from parents, causing the patient pathogenic(Table 1). Then we examined the above-mentioned gene mutation sites of her parents and sisters, and confirmed her double heterozygote of R2102C missense point mutation and I1740fs frameshift mutation site was indeed from father and mother, respectively(Figure 1). Conclusion: In summary, this case report sheds light on rare mutations at 3 sites in FV gene. However, the pathogenic R2102C site identified by ClinVar, together with the I1740fs frameshift mutation site, has not been reported in the literature. On one hand, R2102 occurs in the functional structural region of FV gene, predicting the protein function detrimental, thus considered to be a pathogenic site(Figure 2); on the other hand, since frameshift mutations greatly affect gene function, probably also leading to disease in patients. This is extremely rare. Disclosures No relevant conflicts of interest to declare.

Clinical Presentations and Outcome of Acute Glomerulonephritis in Children

Acute post streptococcal glomerulonephritis (APSGN) is the most common type of acute glomerulonephritis (AGN) in childhood. It has not been studied well in Bangladesh. To evaluate the clinical characteristics, complications and outcome of Acute post streptococcal glomerulonephritis (AGN). the department of Pediatric Nephrology at Sir Salimullah Medical College and Mitford Hospital, Dhaka. A prospective study from April 2011 to March 2012 were conducted among the patients diagnosed as AGN in outdoor and indoor department. Hospital records of all 34 children who had been admitted to Sir Salimullah Medical College and Mitford Hospital were reviewed. All demographic, clinical, paraclinical data and consumed medications were obtained. Among 34 cases female and male ratio were 2.4:1; mean age of was 8.76 yrs. ± 2.5 SD and peak age 7.6. Etiology of AGN was post infectious glomerulonephritis (PIGN) 85.3%, ASO titer was raised in 88.2%, 41.2% had raised blood urea, and 32.4%raised serum creatinine level. All children presented with microscopic hematuria (100%), hypertension (100%), and edema (100%), other findings are fever (55.9%), oliguria (94.1%), abdominal pain (52.9%). History of sore throat and pyoderma was present in 41.2% and 44.1% cases respectively. Complications like hypertensive encephalopathy three (8.8%), urinary tract infection (UTI) one (2.9%) total seven (20%) were heart failure two (5.9%) and Acute kidney injury (AKI) one (2.9%), total seven (20%) were expired. Majority of cases manifest typically with edema, oliguria and hematuria. It usually has an uneventful course.
 Bangladesh Med J. 2019 Jan; 48 (1): 13-17

A CURIOUS CASE OF MYOCARDITIS WITH ELEVATED ANTISTREPTOLYSIN O TITERS

SESSION TITLE: Monday Abstract Posters SESSION TYPE: Original Investigation Posters PRESENTED ON: 10/21/2019 02:30 PM - 03:15 PM INTRODUCTION: Acute rheumatic fever can cause a spectrum of rheumatic heart disease, including myositis, pericarditis, or valvulitis. It is mostly seen in children and is considered a disease of poverty. Here, we present a case of a 24 year-old with myocarditis secondary to rheumatic fever. CASE PRESENTATION: A 24 year-old male presented to the emergency department because of chest pain that started 2 nights prior. His pain was rated 8/10, nonradiating, worse with inspiration and associated with nausea. It was the first time he had experienced chest pain. The patient was recently discharged from the the hospital because of acute tonsillitis, where he experienced throat pain, fever, nausea, vomiting, cervical and submandibular lymph node swelling. He was discharged with improvement of his tonsillitis after treatment with clindamycin. He has no significant past medical history. On physical examination, the patient’s temperature was 38.2*C and heart rate was 103 bpm with the rest of physical examination being unremarkable. Chest X-ray showed bilateral pulmonary congestion with cardiomegaly but no infiltrates or consolidation. EKG revealed diffuse ST segment depression. Laboratory studies showed an elevated white count with normal neutrophil and lymphocyte counts. Troponin levels were elevated from 0.359 ng/mL and peaked to 0.447 ng/mL. Urine toxicology was negative. Blood cultures were taken but returned negative. He was admitted to the telemetry unit with elevated troponin levels to rule out acute coronary syndrome. Cardiology performed an echocardiogram, showing no structural or functional abnormalities; a cardiac catheterization showed the patient had nonobstructive CAD. Throughout his hospital stay, he had fluctuating temperatures, with a Tmax of 38.9*C and developed right knee pain and then pain in the left knee two days later. X-rays were taken of both knees, demonstrating moderate effusion of the right knee. Infectious disease was consulted and recommended ASO titers, influenza Ag, stool culture, and gonorrhea and chlamydia urine PCR. All results of the laboratory test were negative except for the ASO titer of 1:200, CRP of 309.1 mg/dL, and ESR of 114 mm/hr. He was started on naproxen as well as benzathine penicillin G with a diagnosis of myocarditis secondary to rheumatic fever. The patient showed much improvement throughout the course of hospital stay and was discharged to follow up with cardiology and infectious disease clinics. DISCUSSION: The differential diagnosis for a young adult with chest pain is usually secondary to drugs or chest wall pain. It is very unusual for a young adult to present with myocarditis secondary to rheumatic fever, which is more commonly seen in children. It is pertinent to consider acute myocarditis associated with GAS tonsillitis as a differential. CONCLUSIONS: An early diagnosis and treatment can significantly improve the prognosis of the patients. Reference #1: Jose L. Aguirre, MD, Margarita Jurado, MD, Mateo Porres-Aguilar, MD, Cristina Olivas-Chacon, MD, Mateo Porres-Muñoz, MD, Debabrata Mukherjee, MD, and  Juan Taveras, MD. Acute nonrheumatic streptococcal myocarditis resembling ST-elevation acute myocardial infarction in a young patient. DISCLOSURES: No relevant relationships by Obed Adarkwah, source=Web Response No relevant relationships by Hung-I Liao, source=Web Response No relevant relationships by Nitin Tandan, source=Web Response

Establishing Cutoffs for Streptococcal Antibody Titers in Uganda: Implications for Rheumatic Fever Diagnosis

Background: Central to rheumatic fever (RF) diagnosis is evidence of streptococcal exposure, specifically antistreptolysin O (ASO) and antideoxyribonuclease B (ADB) antibodies. It is unknown if these antibody titers should be adjusted to the background exposure rates of GAS or if published standards should be used. Here, we establish the normal values of ASO and ADB in Uganda and examine RF case detection using published vs. population-specific thresholds. Methods: Participants (age 0-50 years) were recruited. ASO was measured in-country by nephelometric technique. ADB samples were sent to Australia (PathWest) for ADB determination by enzyme inhibition assay, and 80% upper limit values by age were established. The published standard values for ASO (200IU/ml) and ADB (375IU/ml) were compared to the Ugandan 80% upper limit of normal values (ULN) for RF case detection in children 5-15 years. Findings: Of the 428 participants, 16 were excluded (9 sore throat, 1 skin sores, 5 fever, 4 echocardiograms showing occult RHD), and 183 of the remaining were children 5-15 years. The median ASO titer in this age group was 220 IU/ml, with the 80th percentile value of 389 IU/ml. The median ADB titer in this age group was 375 IU/ml, with the 80th percentile value of 568 IU/ml. Application of new Ugandan cutoffs to 528 children enrolled in our prospective RF study, reduced the number of definite RF cases to 120/528 (22·7%), as compared to 173/528 (32·8%) using published normal values. Interpretation: The 80th percentile ULN for ASO and ADB are higher in Uganda than in other countries. Applying these higher values to RF diagnosis in Uganda results in higher diagnostic specificity, but some unknown loss in sensitivity. Implications of over-diagnosis and missed cases will be explored through a longitudinal follow-up study of children in the RF research program. Funding Statement: This work was supported by the American Heart Association (#17SFRN33670607), the DELTAS Africa Initiative (DEL-15-011 to THRiVE-2), and General Electric. Declaration of Interests: There were no conflicts of interest in conducting this study. Ethics Approval Statement: Institutional review board (IRB) approval was obtained from the Research and Ethics Committee at Makerere University School of Medicine, the Children’s National Medical Center IRB, and the Uganda National Council for Science and Technology IRB. We approached all participants for their consent, and the study was explained in detail by a research nurse in the participants’ primary language. All participants provided written informed consent before information was collected and children were enrolled only if written consent was obtained from a parent or guardian and written assent by children aged 8 years or older.

Analysis of the Clinical Characteristics and Follow-up Study of Children with Cutaneous Polyarteritis Nodosa.

This study aims to analyze the clinical characteristics, treatment and prognosis of children with cutaneous polyarteritis nodosa (CPAN), in order to improve the understanding of this disease. Data of 14 children with CPAN, who were hospitalized in the Beijing Children's Hospital of Capital Medical University from January 2006 to December 2016, were collected. The clinical characteristics of all patients were summarized, the antistreptolysin-O (ASO)-positive and ASO-negative groups were compared, and the follow-up results were analyzed. X2-test, Fisher's exact probability test, t-test and Mann-Whitney test were used for statistical analysis. Among these 14 CPAN patients, nodular rash was the most common manifestation (14/14). The ASO-positive group had more nodules in the lower limbs and the ASO-negative group appeared more in the upper limbs, which were statistically significant (p<0.05). ASOpositive children were more likely to have joint symptoms (P<0.05), and were more prone to elevated white blood cells (P<0.05). Follow-ups were performed on nine patients, and the prognoses were all good. The occurrence of systemic polyarteritis nodosa was not observed. The main clinical manifestation of children with CPAN is skin nodules, which rarely affects the internal organs. Streptococcal infection is often the main cause. Anti-infection treatment should be simultaneously considered.

CORRELATION OF TOTAL COUNT (WBC), NEUTROPHIL COUNT AND CRP TEST AMONG FEBRILE PATIENTS IN NAVIMUMBAI.

150 febrile patients included children (50), adult (50) and neonates (50) from outpatient departments and inpatients of private clinics and hospitals. Patients presented with fever and chills for more than 1 day to 3 days, throat infection, ear infection and cold and fever and only fever as the principal symptoms. After clinical examination all the patients were prescribed for Complete Blood Count (CBC) with differential count(DC) and C-reactive protein(CRP) tests, and in children below 14 years anti-Streptolysin O(ASO) tests ( 75) were prescribed.&#x0D; Patients treated with antibiotics previously two weeks before the study period were not included. Qualitative and quantitative tests were performed on all patients’ samples included in the study depending on the need/prescription by the physician or paediatrician. CBC, neutrophil count and CRP have been very useful indicators and significant in the diagnosis and treatment as well as follow-up of the febrile condition of the patients specially in patients suffering with bacterial infections. Even in patients with Dengue and malaria it gives a fair idea if there were leucocytosis or leukopenia, neutrophilia or neutropenia, thrombocytosis or thrombocytopenia.&#x0D; CBC: Complete blood count, DC: Differential count; MP: malarial parasite, CRP: C-reactive protein, ASO: Anti-Streptolysin O.

20. A challenging diagnosis of adult-onset Still’s disease in the setting of raised anti-streptolysin O titres

20. A challenging diagnosis of adult-onset Still’s disease in the setting of raised anti-streptolysin O titres

The prevalence of Beta Hemolytic Streptococcus in a Children’s Tertiary Care Hospital in Timisoara

Abstract Background. Beta hemolytic streptococcus (BHS) represents a worldwide health problem because of the complications that can occur. Thus, it is important to identify the presence and type of BHS in time to start treatment if needed, avoiding the complications. Aim. Our aim was to identify the prevalence of Beta Hemolytic Streptococcus in a Children’s Tertiary Care Hospital in Timisoara. Methods. A cross-sectional study was conducted from April-June 2018 in Emergency Hospital for Children Timisoara. The study lot consists from 1100 children, ages between 0-18 years, which were not given, in the preceding two weeks, any antibiotics. We compared the study with two studies from different cities in Nepal, with the same subject as ours. Group A and Group C Streptococci were identified by beta hemolytic colonies, bacitracin sensitivity, catalase negativity test and latex agglutination test (Oxoid Streptococcal Grouping kit). ASO (Antistreptolysin O) test was also performed from serum samples, for patients with positive cultures. We also tested the antibiotic sensitivity to: Cefepime, Clindamycin, Erythromycin, Tetracycline. Results. The prevalence of BHS (Beta Hemolytic Streptococcus), especially GABHS (Group A Beta Hemolytic Streptococcus) was 4%, in children from a tertiary care hospital in Timisoara, Romania; which is comparable to the findings of similar studies. In the first study, the prevalence of GABHS was 7.2%, and in the second study was 9%. The patients with positive cultures were also tested for ASO, 28 patients (52%) had high levels, while 26 (48%) had normal levels. On all positive patients an antibiogram was made and we observed that most of the isolates were sensitive to the antibiotics used. A few isolates in Group A were resistant. Conclusions. Considering the limited data found on our subject, further epidemiological studies on streptococcal disease complex are needed.

Correlation of clinical and laboratory parameters of acute glomerulonephritis in children

Background: The present study was conducted to study the clinical and laboratory parameters of acute glomerulonephritis in children admitted in the department of Pediatrics, Katuri Medical College and Hospital, Guntur.Methods: A prospective study was done at Katuri Medical College and Hospital in all children who are clinically diagnosed edema, oliguria, Cola coloured urine and hypertension. Children presenting with Oliguria, Oedema, Haematuria, Hypertension, Pharyngitis or skin lesions were included, both genders male and female. 50 cases of post-streptococcal glomerulonephritis were evaluated by taking detailed history, thorough clinical examination and appropriate investigation were done for establishment of diagnosis. Lab investigations, CUE, RFT, ASO titres, Serum Complement were done. All the statistical analysis was performed by using EPI INFO 3.5-1. The results were expressed as percentages. Test of significance was done by chi square test. P&lt;0.05 was considered significant.Results: 4156 cases were admitted, out of which 50 cases were having acute glomerulonephritis comprising of 1.2%. The incidence of glomerulonephritis was more from July to December. The sex ratio from male to female is 1.17:1. The incidence of glomerulonephritis was more in children coming from low socio-economic families. Signs wise analysis of glomerulonephritis, it was observed that puffiness of face, edema feet and hypertension were the common features. Incidence of hyper tension were more in male children than female children. The incidence of edema and proteinuria are the commonest clinical presentation. The comparison between incidence of oliguria and blood urea is statistically significant. 1/4th of patients of oliguria are associated with increase serum creatinine level.Conclusions: Acute glomerulonephritis is completely a preventable and completely curable disease if proper precaution is like personal hygiene is observed. Proper knowledge of pathophysiology of glomerulonephritis is important for proper management, institution on appropriate treatment and careful follow up of cases are the corner stones for successful outcome of patients.

Comparison of antistreptolysin O and anti-deoxyribonucleic B titers in healthy children to those with acute pharyngitis, acute rheumatic fever, and rheumatic heart disease aged 5-15 years.

Background:Acute rheumatic fever (ARF) affects millions of children in the third world countries like India. The diagnosis of rheumatic fever is based on the Jones criteria with serological titers, antistreptolysin O titer (ASO), and anti-deoxyribonucleic B (ADB), taken as evidence of recent streptococci infection. There is a lack of recent data available on ASO and ADB titers in children from the Delhi/NCR and thus adequate geographical area-specific cutoffs for the region are not available.Aims and Objectives:The aim of this study is to determine and compare the ASO and ADB antibody titers in children with acute pharyngitis, ARF, rheumatic heart disease (RHD), and in healthy children of the Delhi/NCR region.Materials and Methods:Twenty-six cases of ARF, 51 cases of RHD, 50 cases of acute pharyngitis, and 84 healthy normal children were included in the study. A single ASO and ADB titer measurement was done in these children.Results:The ASO titers was raised in acute pharyngitis – 303 IU/ml (interquartile range [IQR], 142–520 IU/ml) and ARF – 347.5 IU/ml (IQR, 125–686 IU/ml) children in comparison to healthy controls – 163.5 IU/ml (IQR, 133–246.5 IU/ml) and RHD patients – 163 IU/ml (IQR, 98.250–324.500). The ADB titers were highest in ARF patients – 570.5 IU/ml (IQR, 276–922 IU/ml) followed with RHD – 205 IU/ml (IQR, 113.6–456.5), healthy controls – 78.25 IU/ml (IQR, 53.39–128.15 IU/ml), and acute pharyngitis – 75.12 IU/ml (IQR, 64.5–136 IU/ml). The upper limit of normal (ULN) values of ASO and ADB computed from normal healthy children were 262.4 IU/ml and 134.44 IU/ml, respectively, and these can be used as cutoff values for recent streptococcal infection in this geographical area.Conclusions:The median ASO titers in acute pharyngitis group and ARF were significantly raised compared to that of the control group. The ADB titers were raised in ARF and RHD patients albeit the levels were higher in ARF patients. The derived ULN values can be used as cutoff reference.