Antibody Titers in Acute Rheumatic Fever

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Abstract
Specific diagnostic tests for acute rheumatic fever are not presently available. Antibody tests, although indicating the probability of a recent streptococcal infection, do not differentiate individuals convalescent from an uncomplicated infection from those who develop acute rheumatic fever. The antibody response to different streptococcal antigens varies independently following infection, with no more than about 80 to 85% of patients showing a response to any single antigen. If antibody responses to multiple antigens are looked for, this figure will approach 100%. The antistreptolysin O (ASO) determination is probably the best antibody test available. Because some patients fail to show a definite antibody response to this antigen, the performance of one or more secondary antibody tests is desirable. Two recently described streptococcal antibody tests, anti-desoxyribonuclease B (anti-DNAse B) and anti-diphosphopyridine-nucleotidase (anti-DPNase), seem to offer distinct advantages over the antihyaluronidase and antistreptokinase tests, both as individual as well as supplementary tests to the ASO.