Streptococcal Serology Research Articles

Streptococcal Serology in Children With Stuttering.

Introduction: Stuttering is a pronunciation disorder represented by repetitive perpetuations, duplications, or freezes of spoken words or syllables, as well as nervousness and cognitive shunning. Group A beta-hemolytic Streptococcus (GABHS) can lead to pediatric autoimmune neuropsychiatric disorders associated with streptococcal infection (PANDAS). Many case reports have proposed that stuttering is the result of a PANDAS, and that it can be identified together with Tourette syndrome, which shares many clinical characteristics with stuttering. Aim: The purpose of this study was to examine the association between streptococcal serology and stuttering in children. Method: The participants in this study are 26 children who stutter (CWS; mean age = 8.3 + 3.1 years) and 25 children who do not stutter (CWNS; mean age = 9.2 + 2.9 years). Participants were matched in terms of age (±3 months) and gender. We analyzed serum antistreptococcal antibodies [antistreptolysin O (ASO), anti-deoxyribonuclease B (anti-DNase B), and antistreptokinase] in both groups. Results: In the CWS group, ASO, anti-DNase B, and antistreptokinase were significantly higher than in the CWNS group (P < .0001, P < .0001, P < .0001). Conclusion: The higher serum antistreptococcal antibody amounts in CWS suggest that an increased autoimmune response against GAHBS may be the etiology of childhood stuttering. It has been suggested that CWS should be examined for autoimmune reactions, especially to GAHBS.

Comparison of streptococcal serology reporting to ‘The 2020 Australian guideline for prevention, diagnosis and management of acute rheumatic fever and rheumatic heart disease’

Comparison of streptococcal serology reporting to ‘The 2020 Australian guideline for prevention, diagnosis and management of acute rheumatic fever and rheumatic heart disease’

Abstract 13788: Systematic Review: Utility of Human Immune Responses to Group A Streptococcus Antigens as a Diagnostic Indicator for Acute Rheumatic Fever

Introduction: Previous studies have established that group A streptococcus (GAS) antibody titre is correlated with a diagnosis of acute rheumatic fever (ARF). However, results vary in the usefulness of GAS antibodies, particularly anti-Streptolysin-O (ASO) and anti-DNase B, in confirming a recent GAS infection. Therefore, we sought to provide, from published studies, an evidence-based synthesis of the correlation of streptococcal serology to establish the usefulness of immunological data in aiding the diagnosis of ARF. These findings are anticipated to have implications where echocardiography is not freely available, especially where ARF is rampant. Methods: We conducted a comprehensive search across a number of databases. Applying a priori criteria, we selected articles reporting on studies, regardless of study design, that evaluate the levels of antibodies against GAS-specific antigens in ARF subjects against control values or a published standard. Data were extracted onto data extraction forms, captured electronically and analysed using STATA software. Risk of bias was assessed in included studies using the Newcastle-Ottawa Scale . Results: The search strategy yielded 534 studies, from which 24 met the inclusion criteria, reporting on evaluation of titres for SLO (n=10), DNase B (n=9), anti-streptokinase (ASK) (n=3) amongst others. Elevation in titres was determined by comparison with controls and upper limit of normal (ULN) antibody values as determined in healthy individuals. Meta-analysis of case-controlled studies revealed moderate odds ratio (OR) correlations between ARF diagnosis and elevated titres for SLO (OR=10.57; 95% CI, 3.36 to 33.29; 10 studies) and DNase B (OR=6.97; 95% CI, 2.99 to 16.27; 7 studies). Conclusions: While providing support for incorporating SLO and DNase B in the diagnosis of ARF, we present the following reflections: an elevation in SLO and DNase B levels are not consistently associated with an ARF diagnosis; increasing the number of GAS proteins in the test is warranted to improve sensitivity; paired (acute and convalescent) samples could provide a more accurate indication of a rising titre. Use of community-based controls as a standard is not a reliable marker by which to gauge recent GAS infection

Development and Evaluation of a New Triplex Immunoassay That Detects Group A Streptococcus Antibodies for the Diagnosis of Rheumatic Fever.

Streptococcal serology is a cornerstone in the diagnosis of acute rheumatic fever (ARF), a postinfectious sequela associated with group A Streptococcus infection. Current tests that measure anti-streptolysin O (ASO) and anti-DNaseB (ADB) titers require parallel processing, with their predictive value limited by the low rate of decay in antibody response. Accordingly, our objective was to develop and assess the diagnostic potential of a triplex bead-based assay, which simultaneously quantifies ASO and ADB together with titers for a third antigen, SpnA. Our previous cytometric bead assay was transferred to the clinically appropriate Luminex platform by coupling streptolysin O, DNaseB, and SpnA to spectrally unique magnetic beads. Sera from more than 350 subjects, including 97 ARF patients, were used to validate the assay and explore immunokinetics. Operating parameters demonstrate that the triplex assay produces accurate and reproducible antibody titers which, for ASO and ADB, are highly correlative with existing assay methodology. When ARF patients were stratified by time (days following hospital admission), there was no difference in ASO and ADB between <28 and 28+ day groups. However, for anti-SpnA, there was a significant decrease (P < 0.05) in the 28+ day group, indicative of faster anti-SpnA antibody decay. Anti-SpnA immunokinetics support very recent group A Streptococcus infection and may assist in diagnostic classification of ARF. Further, bead-based assays enable streptococcal serology to be performed efficiently in a high-throughput manner.

Bertolt Brecht. Did he really have rheumatic fever?

The writer Bertolt Brecht (1898-1956) is known for his poems, dramas and the "epic or dialectical theater" he founded. He was retrospectively postulated to have had rheumatic fever because of heart problems and neuromuscular symptoms in his youth. Based on current rheumatological knowledge, it cannot be deduced with certainty from the available documents that Brecht had rheumatic fever. At most, avery unusual manifestation of rheumatic fever can be suspected with atypical rheumatic chorea and avery atypical course of rheumatic carditis. Several deviations from the classical clinical picture-the absence of fever and arthritis, no typical symptoms of Sydenham's chorea, the lack of a diagnosis of heart valve defects in adolescence-lead to extensive differential diagnostic considerations. Apossible psychosomatic origin through functional heart complaints must even be postulated if atemporary previous organic cause cannot be excluded. Only the use of the advanced diagnostics available today with Doppler sonography of the heart, cardiac magnetic resonance imaging (MRI), throat swabs for Streptococci and streptococcal serology would have made it possible to diagnose Brecht's cardiac symptoms in his adolescence without adoubt and to differentiate them from functional heart complaints. His death is verified by medical documents clearly documenting bacterial endocarditis with evidence of coli bacteria caused by urological interventions with subsequent febrile episodes and pyelonephritis.

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.

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

SUN-059 Uvular Angioedema

Sixty two year old Caucasian man with past medical history of Hypertension, Coronary artery disease, Congestive Heart Failure (CHF) and Hypothyroidism secondary to radio-ablation of thyroid, presented to Emergency Room with complaints of shortness of breath and swelling of his neck for one day. Initial vitals on admission showed elevated BP (178/100 mm Hg) and pulse oximetry showed 92 % saturation with 2L O2 via nasal canula. Physical examination was normal except for increased neck circumference and pitting edema in both feet. Labs revealed elevated BNP at 2330 pg/ml (<125), elevated TSH at 13 uIU/ML (0.5 -5), with low T3 at 0.79 ng/ml (0.9 - 1.6). Rapid Group A streptococcal serology was negative. Patient had previous allergy to Angiotensin Converting Enzyme Inhibitor (ACEI) with lip swelling five years ago and has since been taking Angiotensin Receptor Blocker (ARB) - Losartan for Heart Failure with preserved ejection fraction (HFpEF) without any complaints, until this episode one day ago. Initial X-ray of the neck revealed epiglottic narrowing and subsequent CT scan showed uvular thickening. The uvular angioedema was likely worsened due to ARB, with possible contribution from exacerbation of diastolic heart failure and hypothyroidism. He was started on hydralazine and intravenous furosemide for CHF exacerbation in addition to continuing home medication of metoprolol and stopping Losartan. The dose of Levothyroxine was titrated for hypothyroidism. Patient was given intravenous dexamethasone, famotidine, and diphenhydramine in the hospital, with which the swelling subsided within a day and he felt symptomatically better. Oxygen was weaned off and saturation was 95 % on room air, BP was controlled at discharge. Losartan was hence stopped and he was sent home on steroid taper. Subsequent follow up at six months revealed that he did not develop any further episodes of angioedema subsequent to stopping Losartan. ARB is sometimes prescribed to patients having intolerance to ACEI. Previous reports suggest that patients who develop angioedema with ACEI, may also develop allergy with ARB, and is hence best avoided. This case illustrates that caution needs to be exercised in transitioning patients from ACEI to ARB, and that allergy may manifest as isolated uvular edema, especially in patients with multiple comorbidities.

Potential for Molecular Testing for Group A Streptococcus to Improve Diagnosis and Management in a High-Risk Population: A Prospective Study.

BackgroundIn high-burden settings, guidelines recommend antibiotic treatment for all suspected group A Streptococcus (GAS) infections to prevent rheumatic fever and poststreptococcal glomerulonephritis. Highly sensitive rapid GAS tests could reduce unnecessary antibiotic use in these settings.MethodsThis was a prospective study of the Xpert Xpress Strep A (Cepheid) molecular test compared with culture of throat swab samples collected at a referral hospital in northern Australia. Demographic and clinical data and results of streptococcal serology and culture were collected.ResultsOf 164 throat swab samples, 145 (88%) were eligible for inclusion; 49 (34%) were molecular test positive and 24 (17%) were culture positive for GAS. The sensitivity, specificity, and positive and negative predictive values for the molecular test versus culture were 100.0%, 79.3%, 48.8%, and 100.0%, respectively. Among 25 samples testing positive with the molecular test and negative with culture, group C or G streptococci were cultured in 2, and a plausible clinical explanation, such as pharyngotonsillitis, or rheumatic fever with positive results of streptococcal serology, was apparent in 19 instances. In 25 patients with rheumatic fever or poststreptococcal glomerulonephritis diagnoses, molecular testing nearly trebled the detection of GAS in throat swab samples, from 3 (12%) detected with culture to 8 (32%) detected with molecular testing. Reasons for “false-positive” molecular test results could include the presence of GAS below the threshold of culture detection or persistence of nonviable organisms after infection.ConclusionImplementation of molecular testing could improve antibiotic use in this high-burden setting. The incremental yield in poststreptococcal syndromes, by which time cultures are negative, has high potential in the diagnostic workup of autoimmune poststreptococcal syndromes and warrants further investigation.

Streptococcal Serology in Acute Rheumatic Fever Patients: Findings From 2 High-income, High-burden Settings.

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). 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. 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. 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.

P44 Streptococcal serology in a two-year cohort of patients with juvenile idiopathic arthritis: practical guidance

P44 Streptococcal serology in a two-year cohort of patients with juvenile idiopathic arthritis: practical guidance

Understanding protective plasma levels of penicillin and monitoring antibody responses for the prevention of GAS infection in a paediatric population in New Zealand

Abstract Acute Rheumatic Fever (ARF) is an autoimmune condition resulting from untreated Group A Streptococcal (GAS) infection of the upper respiratory tract and possibly skin. Repeated untreated and severe episodes of ARF can cause permanent cardiac damage known as Rheumatic Heart Disease (RHD). Rates of ARF in New Zealand and Australia are among the highest in the world, particularly amongst Māori and Pacific and Indigenous Aboriginal children. Monthly injections of Benzathine Penicillin G (BPG) are given intramuscularly to prevent GAS infections that can lead to ARF and cause RHD. Early studies exploring the Pharmacokinetics (PK) properties of BPG were conducted in healthy, fit, young military recruits without ARF/RHD. BPG bioavailability, metabolism may differ in paediatric populations groups with ARF who have comorbidities and vary in Body Mass Index. This project seeks to determine the PK characteristics in a paediatric population currently receiving monthly injections of BPG while at the same time monitoring antibody immune responses to possible GAS infections. This is a prospective cohort study in a paediatric population of Wellington based children and teens (aged 5–21 years of predominantly Pasifika and Māori heritage) with a previous diagnosis of ARF and are receiving monthly BPG injections via community services. Participants will contribute finger prick blood samples over time for Dried Blood Spot assays designed to quantify penicillin G levels in the blood and measure streptococcal serology. Routine throat swab samples will also be collected with ASOT antibody levels monitored for GAS breakthrough infections. This is the first population PK study exploring use of BPG in Māori and Pacific children previously diagnosed with ARF.

The novel Group A Streptococcus antigen SpnA combined with bead-based immunoassay technology improves streptococcal serology for the diagnosis of acute rheumatic fever

ObjectivesStreptococcal serology provides evidence of prior Group A Streptococcus (GAS) exposure, crucial to the diagnosis of acute rheumatic fever (ARF) and post-streptococcal glomerulonephritis. However, current tests, which measure anti-streptolysin-O and anti-DNaseB antibodies, are limited by false positives in GAS endemic settings, and incompatible methodology requiring the two tests to be run in parallel. The objective was to improve streptococcal serology by combining the novel GAS antigen, SpnA, with streptolysin-O and DNaseB in a contemporary, bead-based immunoassay. MethodsRecombinant streptolysin-O, DNAseB and SpnA were conjugated to polystyrene beads with unique fluorescence positions so antibody binding to all three antigens could be detected simultaneously by cytometric bead array. Multiplex assays were run on sera collected in three groups: ARF; ethnically matched healthy children; and healthy adults. ResultsThe ability of the antigens to detect a previous GAS exposure in ARF was assessed using the 80th centile of the healthy children group as cut-off (upper limit of normal). SpnA had the highest sensitivity at 88%, compared with 75% for streptolysin-O and 56% for DNaseB. ConclusionsSpnA has favorable immunokinetics for streptococcal serology, and can be combined with anti-streptolysin-O and anti-DNaseB in a multiplex format to improve efficiency and accuracy.

Case-control, exploratory study of cerebrospinal fluid chemokines/cytokines and lymphocyte subsets in childhood Tourette syndrome with positive streptococcal markers

A longstanding question is whether neuroinflammation is present in children symptomatic for Tourette syndrome (TS) with positive streptococcal serology and throat cultures. The objective was to directly test for it using modern hypothesis-driven approaches. Profiling studies for 14 immune cell types (flow cytometry), 7 chemokines/cytokines (ELISA), oligoclonal bands, and other immunoglobulins were performed in this IRB-approved study of 5 children with TS and streptococcal markers compared to data from 26 non-inflammatory pediatric neurological controls. Subjects were well-characterized clinically and with standardized scales for tics and obsessions/compulsions. Three subjects with TS (60%) had positive throat cultures for Group A beta-hemolytic strep, five had elevated anti-deoxyribonuclease-B titers (mean=444), and 4 (80%) had elevated anti-streptolysin O titers (981). There were no significant differences between groups in the frequency of CSF B and T cell subsets or NK cells; the proportion of intracellularly-stained T helper type 1 (IFN-γ) or type 2 (IL-4) cells; the concentrations of B cell chemoattractants CXCL13, CXCL10; the B cell proliferation/survival cytokines BAFF and APRIL, or other chemokines (CCL19, CCL21, CCL22). None of the patients had positive CSF oligoclonal bands or an abnormal IgG index/synthesis rate. Parallel blood studies were negative. This novel study found no group CSF lymphocyte phenotypic abnormalities or elevated inflammatory mediators in childhood TS despite positive serology and throat cultures for Group A beta-hemolytic streptococci. It demonstrates feasibility of the methodology, and should serve as the basis for a larger study of putative streptococcal-associated neuroimmunological disorders.

Anti Streptolysin O; Normal Values for Healthy Children Aged from 5 to 15 Years Old in Sana'a City-Yemen

Backgrounds: Group-A streptococcal serology is used for the diagnosis of poststreptococcal diseases, such as acute rheumatic fever, and occasionally for the diagnosis of streptococcal pharyngitis. Experts recommend that the upper limits of normal values for streptococcal serology should be determined for each individual population because of differences in the epidemiology of group A Streptococci (GAS) between these populations. Objectives: This study was conducted firstly to determine the normal values of the upper limit of anti-streptolysin O (ASO) titer in Sana'a city. Secondly to determine the factors that might affect the levels of ASO among the selected children. Methods: Participants with a history of GAS disease, including pharyngitis or impetigo were excluded. A total of 404 serum samples collected from children aged 5-15 years (with a sample enriched with school-aged children) were tested for the ASO titer. Reference values, including titers that were 95% of the upper limit of normal (ULN) were obtained by the calculation of 95% prediction interval (PI 95%) using a parametric method instead of the traditional non parametric approach. Results: Normal values for the ASO titer declined in the early childhood and rose slightly in the late childhood. The estimated ASO titers that were 95% of ULN for the total was 276.2 IU/ml. Conclusions: This study data were similar to those reported in countries with temperate climates, suggesting that a uniform upper limit of normal for streptococcal serology may be able to apply globally.

Evidence of streptococcal origin of acute non-necrotising cellulitis: a serological study.

Bacteriological diagnosis is rarely achieved in acute cellulitis. Beta-haemolytic streptococci and Staphylococcus aureus are considered the main pathogens. The role of the latter is, however, unclear in cases of non-suppurative cellulitis. We conducted a serological study to investigate the bacterial aetiology of acute non-necrotising cellulitis. Anti-streptolysin O (ASO), anti-deoxyribonuclease B (ADN) and anti-staphylolysin (ASTA) titres were measured from acute and convalescent phase sera of 77 patients hospitalised because of acute bacterial non-necrotising cellulitis and from the serum samples of 89 control subjects matched for age and sex. Antibiotic treatment decisions were also reviewed. Streptococcal serology was positive in 53 (69%) of the 77 cases. Furthermore, ten cases without serological evidence of streptococcal infection were successfully treated with penicillin. Positive ASO and ADN titres were detected in ten (11%) and three (3%) of the 89 controls, respectively, and ASTA was elevated in three patients and 11 controls. Our findings suggest that acute non-necrotising cellulitis without pus formation is mostly of streptococcal origin and that penicillin can be used as the first-line therapy for most patients.

Erythema nodosum — A diversity of diagnostic potential!

Erythema nodosum results from an inflammatory reaction in the subcutaneous fat and is characterized by acute onset of painful and ill-defined erythematous nodules that can best be seen than felt. Is associated with many differential diagnoses such as infections, drugs, sarcoidosis, inflammatory bowel disease and cancer. What was the etiology present in this case. The authors describe a case of a woman of 72 years old, living in rural areas. Personal history of hypertension and dyslipidemia was medicated with perindopril, indapamide and statin. Admitted by symptoms such as anorexia, weight loss (not quantified), fever and neck pain with 8 days of evolution, associated with the onset of painful erythematous nodules around the abdomen, upper and lower limbs two days before. The patient denied sore throat or flu-like illness in the previous weeks, as well as foreign travel, other new medications or relatives with the same symptoms. On physical examination no changes except painful erythematous nodules in the abdomen, back, upper and lower limbs, in different stages of evolution. Analytically had macrocytic normochromic anemia (9.6 g/dL), leukopenia (3300/μL), increased erythrocyte sedimentation rate (112 mm/h) and monoclonal peak range on the electrophoresis (IgM/kappa). The remaining analytical study performed, including immune, angiotensin converting enzyme, TASO (streptococcal serology) and bacterial, viral or fungal infection, was negative, as all microbiological research. All body CT-scan and digestive endoscopies without any evidence of pathology. Bone marrow biopsy was performed with the diagnostic of myelodysplastic syndrome (refractory anemia with excess blasts (RAEB-1)), checking the presence of 7% blasts and complex karyotypes with multiple chromosomal abnormalities, including del 5q - 16%. With this result it was decided by treatment with Azacitidine. The cause of erythema nodosum is a diagnostic challenge on the Internal Medicine because of the diversity of pathologies associated with it (from a pharyngitis to a neoplasm). With this case report, the authors intend to demonstrate that the presence of myelodysplastic syndrome can also manifest as erythema nodosum, which must be part of the differential diagnosis of this panniculitis.

Epidemiology of streptococcal infection with reference to Rheumatic fever

Introduction: Group A hemolytic streptococcal infections have a worldwide distribution among children and it poses an important health problem globally. Group A streptococcal (GAS) serology is used for the diagnosis of post-streptococcal diseases, such as acute rheumatic fever, post-streptococcal Glomerulonephritis and occasionally for the diagnosis of streptococcal pharyngitis. Upper normal limits for streptococcal serology should be determined for individual populations because of differences in the epidemiology of GAS between populations. Material & Methods: Study materials were divided in 3 groups. Group-A (normal children population), group- B (children clinically diagnosed as acute bacterial sore throat) and group-C (children clinically diagnosed rheumatic fever). ASO titer & throat culture were assessed in all three groups. Result: When cut off range of ASO titer is >200 IU/ml, it is positive in 20%, 38% and 54.4% in Group A, B and C respectively. But When titer range increased to >400 IU/ml, it was positive in 40 %, 36.84% and 44.44% cases from Group A, B & C respectively. Conclusion: Cut off point of 200 IU/ml has limitations in our setup. Use of western cut off 200 IU/ml needs to be revised in relation to local epidemiology to get less false positive results.

A year in the life of the streptococcus

Introduction Mild streptococcal infections infection are extremely common, however invasive infections can lead to high mortality. Described in 1982, post streptococcal reactive arthritis (PSRA) has been reported with increasing frequency. Aim We aimed to look at the number of children presenting to a Tertiary Children9s Hospital, with serological significant streptococcal illnesses, diagnoses and antibiotic treatment of those patients. We aimed to identify the patient population with possible Rheumatological conditions, and those who were seen in Rheumatology clinic. Method We looked at the number of patients where Antistreptolysin O test (ASOT) were performed. Results > 400 were reviewed. Patient case notes were reviewed for diagnosis, antibiotics prescribed and duration of treatment. Results Department & Number of patients seen in 2009 Emergency Department 46 700 GP referral unit 4861 General medical clinic new referrals 9776 General medical clinic follow-up 39 915 Rheumatology clinic new referral 19 Rheumatology clinic follow-up 338 ASOT9s ASOT9s January 2009–December 2010=645 N patients=359 N ASOT9s >400=100 (28%) Notes reviewed=95/100 patients Diagnoses & Number of patients Urticaria 11 Tonsillitis 9 Pneumonia/empyema 8 Lymphadenopathy 8 Rheumatological (2 SoJIA, 3 JIA, 2 PSRA, 1 irritable hip) 8 Nephritis/haematuria 7 Dermatology other 7 Recurrent streptococcal illness 5 Vasculitis (HSP 4 Wegeners 1) 5 Asthma/WAVE 4 Chronic Fatigue 3 Meningitis/encephalitis 3 Kawasaki 2 Immunological (PFAFA, Autoimmune) 2 Neurological 2 Fever Unspecified 2 Gastroenterology 2 EBV 2 TB 2 UTI 1 Endocarditis 1 Osteomyelitis 1 N° patients with conditions commonly seen in Rheumatology clinics (Bold above )=25 N° patients seen in the Rheumatology clinic=12 Antibiotics 65/95 were prescribed antibiotics. Length of Antibiotic & Number of Patients 48hrs 1 Up to7 days 15 8–14 days 37 2 weeks–6 weeks 4 >6 weeks 8 Conclusions Less than 1/3 of those patients in whom ASOT9s were performed were significantly raised. 1/4 of patients with positive streptococcal serology had a rheumatological diagnosis, suggesting it is a significant trigger in rheumatological conditions. Learning points ▶Need for education on rational antibiotic policies, allowing appropriate treatment for streptococcal eradication. ▶Possible need for streptococcal screening in rheumatological patients ▶Paediatricians should consider rheumatological conditions in patients with positive results.

054 Association of S. Pyogenes Dna from Throat Swabs of Asymptomatic Children and Very High Prevalence of Rheumatic Heart Disease in Rural South America

054 Association of S. Pyogenes Dna from Throat Swabs of Asymptomatic Children and Very High Prevalence of Rheumatic Heart Disease in Rural South America