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HelpEpic Test Code LAB1193 Streptococcal Antibodies Profile, Serum
Additional Codes
MML Code: SABP
NY State Approved
YesPerforming Laboratory
Mayo Clinic Laboratories in Rochester
Reporting Name
Streptococcal Antibodies ProfileMethod Name
Nephelometry
Specimen Stability Information
| Specimen Type | Temperature | Time | Special Container |
|---|---|---|---|
| Serum | Refrigerated (preferred) | 28 days | |
| Frozen | 28 days | ||
| Ambient | 7 days |
Specimen Required
Patient Preparation: Fasting preferred but not required
Collection Container/Tube:
Preferred: Red top
Acceptable: Serum gel
Submission Container/Tube: Plastic vial
Specimen Volume: 1 mL
Collection Instructions: Centrifuge and aliquot serum into a plastic vial.
Specimen Type
SerumSpecimen Minimum Volume
0.5 mL
Reference Values
ANTISTREP-O TITER
<5 years: ≤70 IU/mL
5-17 years: ≤640 IU/mL
≥18 years: ≤530 IU/mL
ANTI-DNase B TITER
<5 years: ≤250 U/mL
5-17 years: ≤375 U/mL
≥18 years: ≤300 U/mL
Report Available
1 to 3 daysDay(s) Performed
Monday through Friday
CPT Code Information
86060
86215
Reject Due To
| Gross hemolysis | OK |
| Gross lipemia | Reject |
| Gross icterus | OK |
Useful For
Demonstration of acute or recent streptococcal infection using both antistreptolysin O and anti-DNase B titers
Profile Information
| Test ID | Reporting Name | Available Separately | Always Performed |
|---|---|---|---|
| ASO | Antistrep-O Titer, S | Yes | Yes |
| ADNAS | Anti-DNase B Titer, S | Yes | Yes |
Clinical Information
A number of bacterial antigens have been identified in cultures of group A streptococci. These extracellular products are primarily enzymatic proteins and include streptolysin O, streptokinase, hyaluronidase, deoxyribonucleases (DNases A, B, C, and D), and nicotinamide adenine nucleotidase.
Infections by the group A streptococci are unique because they can be followed by the serious nonpurulent complications of rheumatic fever and glomerulonephritis. Recent information suggests that rheumatic fever is associated with infection by certain rheumatogenic serotypes (M1, M3, M5, M6, M18, and M19), while glomerulonephritis follows infection by nephritogenic serotypes (M2, M12, M49, M57, M59, and M60).
Glomerulonephritis and rheumatic fever occur following the infection, after a period of latency following the infection, during which the patient is asymptomatic. The latency period for glomerulonephritis is approximately 10 days, and for rheumatic fever the latency period is 20 days.
Interpretation
Elevated values are consistent with an antecedent infection by group A streptococci.
Cautions
The use of the antistreptolysin O (ASO) for the diagnosis of an acute group A streptococcal infection is rarely indicated, unless the patient has received antibiotics that would render the culture negative. There are certain limitations to the use of the ASO test in these circumstances due to the delay and attenuation of the immune response following early antibiotic therapy.
False-high titers may be obtained with sera that are contaminated by certain bacterial organisms during shipment or storage and in patients with liver disease where the presence of high lipoprotein concentrations in the serum may mimic antibody activity.
Although the antistreptolysin O (ASO) test is quite reliable, performing the anti-DNase is justified for 2 primary reasons. First, the ASO response is not universal. Elevated ASO titers are found in the sera of about 85% of individuals with rheumatic fever; ASO titers remain normal in about 15% of individuals with the disease. The same holds true for other streptococcal antibody tests: a significant portion of individuals with normal antibody titers for 1 test will have elevated antibody titers for another test. Thus, the percentage of false-negatives can be reduced by performing 2 or more antibody tests. Second, skin infections, in contrast to throat infections, are associated with a poor ASO response. Patients with acute glomerulonephritis following skin infection (post-impetigo) have an attenuated immune response to streptolysin O. For such patients, performance of an alternative streptococcal antibody test such as anti-DNase B is recommended.