Clinical and Experimental Pediatrics

The Korean Pediatric Society (대한소아청소년과학회)
권호 표지

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

경인지역에서 조사한 소아의 연령별 antistreptolysin O 역가

  • Lee, Jihun (Department of Pediatrics, College of Medicine, The Catholic University of Korea) ;
  • Kim, Yoo Jung (Department of Pediatrics, College of Medicine, The Catholic University of Korea) ;
  • Bin, Joong Hyun (Department of Pediatrics, College of Medicine, The Catholic University of Korea) ;
  • Hwang, Ja Young (Department of Pediatrics, College of Medicine, The Catholic University of Korea) ;
  • Hahn, Seong Hoon (Department of Pediatrics, College of Medicine, The Catholic University of Korea) ;
  • Kim, So Young (Department of Pediatrics, College of Medicine, The Catholic University of Korea) ;
  • Kim, Hyun Hee (Department of Pediatrics, College of Medicine, The Catholic University of Korea) ;
  • Lee, Wonbae (Department of Pediatrics, College of Medicine, The Catholic University of Korea)
  • 이지헌 (가톨릭대학교 의과대학 소아과학교실) ;
  • 김유정 (가톨릭대학교 의과대학 소아과학교실) ;
  • 빈중현 (가톨릭대학교 의과대학 소아과학교실) ;
  • 황자영 (가톨릭대학교 의과대학 소아과학교실) ;
  • 한승훈 (가톨릭대학교 의과대학 소아과학교실) ;
  • 김소영 (가톨릭대학교 의과대학 소아과학교실) ;
  • 김현희 (가톨릭대학교 의과대학 소아과학교실) ;
  • 이원배 (가톨릭대학교 의과대학 소아과학교실)
  • Received : 2007.06.22
  • Accepted : 2007.08.01
  • Published : 2007.10.15
Download PDF
⟨ Previous Next ⟩

Abstract

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 $149.9{\pm}7.2IU/mL$. The ASO concentration in neonates was $83.4{\pm}10.7IU/mL$, and lowest in the 1 year of age group, $26.7{\pm}6.6IU/mL$, and increased to $318.0{\pm}33.2IU/mL$ 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.

목 적 : Antistreptolysin O(ASO)는 인종, 지역, 역학적 요소에 따라 정상치가 다르므로 시기별, 지역마다 각 연령별 정상치가 필요하다. 경인지역에서 신생아부터 29세까지를 대상으로 연령별 ASO치의 분포를 분석하여 이 지역에서 사용할 수 있는 ASO의 소아 정상치를 확립하고자 하였다. 방 법 : 경인지역에서 2002년 1월에서 2003년 2월 사이의 신생아부터 29세까지 753명(남자 381명, 여자 372명)의 혈청을 이용하여 혈청 내 ASO치를 측정하였다. 전체를 각각 연령별로 분석하고 다시 신생아 군, 0-3세 군, 4-6세 군, 7-9세 군, 10-19세 군과 20-29세 군으로 나누어 ULN를 구하였다. 결 과 : 전체 대상의 ASO치는 $149.9{\pm}197.0IU/mL$였으며, 신생아 군에서 $83.4{\pm}78.7IU/mL$이었고, 이후 점차 떨어져 1세 군에서는 $26.7{\pm}43.0IU/mL$로 가장 낮았다. 이후 점차 증가하여 9세 군에서 $318.0{\pm}250.8IU/mL$로 최고값에 도달한 후 다시 감소하였다. ASO 상한값(upper Limit of Normal: ULN)은 0-3세 군에서 40 IU/mL, 신생아 군에서 122 IU/mL, 4-6세 군에서 113 IU/mL, 7-9세 군에서 489 IU/mL, 10-19 세 군에서 433 IU/mL, 20-29 세 군에서 122 IU/mL 였다. 결 론 : 이상으로 경인지역에서 2002년 1월에서 2003년 2월 사이의 신생아부터 29세까지의 연령별 ASO치의ULN을 설정하였으며, ASO 값의 판정은 소아와 성인간에 다른 ULN을 적용하여야 함은 물론 소아에서도 여러 연령별로 나누어서 ASO ULN치를 적용하여야 함을 알 수 있었다. 이 결과는 향후 환자들의 ASO 결과를 임상적으로 해석하는데 도움이 될 것으로 사료된다.

Keywords

References

  1. Raz R, Bitnum S. Dilemmas of streptococcal pharyngitis. Am Fam Physicians 1987;35:187-92
  2. Committee to Revice the Jones Criteria. American Heart Association. Jones criteria(reviced) for guidence in the diagnosis of rheumatic fever. Circulation 1965;32:664-8
  3. Rantz LA, Randall E, Rantz HH. Antistreptolysin 'O', a study of this antibody in health and in hemolytic streptococcus respiratory disease in man. Am J Med 1984;5:3-23 https://doi.org/10.1016/0002-9343(48)90003-5
  4. Wannamaker LW, Ayoub EM. Antibody titers in acute rheumatic fever. Circulation 1960;21:598-614 https://doi.org/10.1161/01.CIR.21.4.598
  5. Ayoub EM, Wannamaker LW. Evaluation of the streptococcal deoxyribonuclease Band diphosphopyridine nucleotidase antibody tests in acute rheumatic fever and acute glomerulonephritis. Pediatrics 1962;29:527-38
  6. Ayoub EM, Harden E. Immune response to streptococcal antigens: diagnostic methods. In: Rose NR, de Macario EC, Fahey JL, Friedman H, Penn GM, ed. Manual of Clinical Laboratory Immunology. 4th ed. WashingtonD.C.:American society for microbiology, 1992:427-34
  7. Johnson DR, Kaplan EL. Laboratory diagnosis of group A streptococcus infections. Geneva: World Health Organization, 1996
  8. Kaplan E, Anthony B, Chapman S, Ayoub E, Wannamaker L. The influence of the site of infection on the Immune response to group A streptococci. J Clin Invest 1970;49: 1405-14 https://doi.org/10.1172/JCI106358
  9. Kaplan E, Ferrieri P, Wannamaker L. Comparison of the antibody response to streptococcal cellular and extracellular antigens in acute pharyngitis. J Pediatr 1974;84:21-8 https://doi.org/10.1016/S0022-3476(74)80548-2
  10. Kaplan EL, Anthony BF, Ayoub EM, Wannamaker LW. A 2-year longitudinal study of streptococcal infections in an isolated community: antibody dynamics. In: Haverkorn MJ, ed. Streptococcal Disease and the Community. Proceedings of the Fifth International Symposium on Streptococcus Pyogenes. Amsterdam. Excerpta Medica 1974:237-42
  11. Igari J. Kosakai N, Shibazaki S. Antideoxyribonuclease B distribution in health individuals. Jpn Circ J 1983;47:1287-9 https://doi.org/10.1253/jcj.47.1287
  12. Mhalu F, Matre F. Antistreptolysin O and anti-deoxyribonuclease B titers in blood donors and in patients with features of non-suppurative sequelae of group A streptococcus infection in Tanzania. East Afr Med J 1995;72:33-6
  13. Gray G, Struewing J. Hyams K, Escamilla J. Tupponce A, Kaplan E. Interpreting a single antistreptolysin O test: a comparison of the 'upper limit of normal' and likelihood ratio methods. J Clin Epidemiol 1993;46:1181 -5 https://doi.org/10.1016/0895-4356(93)90117-J
  14. Kibukamusoke JW, Tsirkin RS. Normal values in adult Zambians: IX. anti-streptolysin-O-titers. Med J Zambia 1978;12:53-4
  15. Kaplan EL, Rothermel CD, Johnson DR. Antistreptolysin O and anti-deoxynuclease B Titers: normal values for children ages 2 to 12 in the United States. Pediatrics 1998;101;86-8 https://doi.org/10.1542/peds.101.1.86
  16. Seon Ju Kim. Distribution and upper limit of normal antistreptolysin O concentrations of school children in Chinju area. Infect Chemother 1997;29:233-8
  17. Seon Ju Kim, Myung-A Chung, Hyun- Ju Chung, Yun- Jeong Kim, Kook-Young Maeng. Distribution and upper limit of normal antistreptolysin O concentrations according to age. Infect Chemother 1998;30:392-6
  18. Sung-Ho Cha, Yong-Mook Choi, Sei-Won Yang, DongHwan Lee, Chong-Guk Lee, Chan-Ho Hong. Upper limit of normal value for antistreptolysin O titer of healthy children in Seoul. J Korean Pediatr Soc 1995;38:1061-7
  19. Danchin MH, Carlin JB, Devenish W, Nolan TM, Carapetis JR. New normal ranges of antistreptolysin O and antideo xyribonuclease B titers for Australian children. J Paediatr Child Health 2005;41:583-6 https://doi.org/10.1111/j.1440-1754.2005.00726.x
  20. Ayoub EM. Immune response to group A streptococcal infections. Pediatr Infect Dis J 1991; 10(10 Suppj):15S-19S https://doi.org/10.1097/00006454-199101000-00004
  21. Balows A, Hausler Jr WJ, Herrmann KL, Isenberg HD, Shadomy HJ. Manual of clinical microbiology. 5th ed. Washington, D.C. : ASM Press. 1991:76-8
  22. Lancefield RC. Persistence of type-specific antibodies in man following infection with group A streptococci. J Exp Med 1959;110:271-92 https://doi.org/10.1084/jem.110.2.271
  23. McCarthy M. The antibody response to streptococcal infection. In McCarthy M. Streptococcal Infections. New York: Columbia University Press, 1954
  24. Stollerman G, Lewis A, Schultz I, Taranta A. The relationship of the immune response to group A streptococci to the course of acute, chronic and recurrent rheumatic fever. Am J Med 1956;20:163-9 https://doi.org/10.1016/0002-9343(56)90185-1
  25. Fujikawa S, Ohkuni M. Annual changes of upper limit of ASO titer in school children. Jpn Circ J 1983;47:1290-2 https://doi.org/10.1253/jcj.47.1290
  26. Harris TN, Needleman HL, Harris S, Friedman S. Antistreptolysin and streptococcal antihyaluronidase titers in sera of hormone treated and control patients with acute rheumatic fever. Pediatrics 1956;17:29-35
  27. Lippard VW, Wheeler GW. Beta hemolytic streptococcal infection in infancy and in childhood III. placental transmission of antifibrinolysin and antistreptolysin. In. Wannamaker LW, Ayoub EM. Antibody titers in acute rheumatic fever. Circulation 1960;21:598-614 https://doi.org/10.1161/01.CIR.21.4.598
  28. Sun Joo Kim, Myoung Hee Park, Jin Q Kim, Kook Young Maeng. Distribution of antistreptolysin O concentrations and results of throat cultures of school children in Chungnam province and Seoul. Korean J Clin Pathol 1994;14:101-8
  29. Klein GC, Baker CN, Jones WL. 'Upper limits of normal' antistreptolysin O and anti deoxyribonuclease B titers. Appl Microbiol 1971;21:999-1001
  30. Karrnaker MG, Vegugopal V, Josh L, Kamboj R. Evaluation & revaluation of upper limit of normal values of antistreptolysin O & anti deoxyribonuclease B in Mumbai. Indian J Med Res 2004;119 Suppl:26-8