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Serological tests for the detection of C-reactive protein (CRP), Rheumatoid factor (RE) and Anti Streptolysin 'O' (ASLO) antibodies employing latex test were carried out in 120 cases of active lepromatous leprosy, 14 LL cases with ENL during active and subsided phases and 25 controls. Out of 120 LL cases 25.8% gave a positive reaction to CRP and ASLO. Only 4.2% of the cases with LL were positive for Rheumatoid factor. None of the controls showed positive reaction in these tests. During ENL, 100% of the sera showed positive test for CRP as against 35.7% during subsidence of reaction. Tests for RF were positive in 28.5% of the cases ENL as compared to none during subsided ENL. Raised ASLO titers were noticed in 38.2% cases with active ENL as against 21.4% during subsided phase of ENL.

A study demonstrating the relationship between pharyngeal infection of group A streptococci and the antibody response was performed. Group A streptococci were recovered from 44 (9.4%) of 466 children, of which 41 strains were typable by T-protein. Fifty-five percent of 41 children from whom group A streptococci were recovered showed a significant rise in anti-streptolysin O (ASO) titers in sera. In children from whom group A streptococci were recovered and with elevated ASO titers, titers of antideoxyribonuclease B (ADNase B) were significantly higher than those who were negative for group A streptococci and also showed elevated or normal titers for ASO. Patients with acute rheumatic fever demonstrated elevated titers of both ASO and ADNase B. These findings suggest that a combination of ASO and ADNase B titers should be applied to diagnose the streptococcal infections. Antinicotinamideadenine dinucleotidase showed a low level of titers in children who had group A streptococci in their throat and exhibited elevated titers in streptococcal antibodies, and also in patients with acute rheumatic fever.

The clinical value of the immunological tests performed routinely has been evaluated in 91 patients with various histological types of glomerulonephritis. An antigen possibly involved in the pathogeny of renal disease was found in 24% cases. However, in most instances no direct link between the presence of this given antigen and the disease could be observed. Therefore systematic investigations for antigens should be restricted to dosages of antistreptolysin and antinuclear antibodies and to determination of Hbs antigen. Immune complexes, which were observed in many cases, were of no discriminant value for the clinician. Dosages of the complement fractions and the determination of cryoglobulins can be helpful for diagnostic, follow-up and treatment. Our results justify a restricted selection of the routine immunological tests used in patients with glomerulonephritis. More specific investigations remain useful when they are clinically oriented.

In the sera of approximately 600 patients of all age groups, who were on clinical suspicion of an A-streptococcal infection, AST, ADNase B, AHy and ANADase were determined. The ANADase alone detects 90% of the acute A-streptococcal infections, the AHy and the ADNase B 80% and the ASO 50%. In skin infections superinfected by A-streptococci, the AHy is positive in 85%, the ANADase in 80%, the ADNase B in 75% and the AST in 40% of the cases. The most frequent A-streptococcal infection, Angina tonsillaris, is determined in the best manner possible through the combination ADNase B + ANADase + AHy. According to the statistical evaluation, the ADNase B and the ANADase are the most reliable tests. The age group of the 4 to 15 year-olds reaches for ASO, ADNase B and AHy a percentage of highly increased titers twice as high in comparison with the adult group. In no case does one test determine 100% of the collective; therefore, a combination of several antibody reactions is desirable for the diagnosis. Increased titers should be checked every four weeks, also normal titers with patients, who continue on the clinical suspicion of having an A-streptococcal infection, because their blood sample may have been taken before the immune reaction occurred.

Thirty-seven cases of streptococcal rheumatic fever in adults (20 women and 17 men; mean age 33 years) are reported. Only 3 patients had a history of previous rheumatic fever. In 73% of the cases untreated sore throat had occurred 8 to 30 days before the condition developed. Throat swabs taken during the rheumatic attack were positive for Streptococcus haemolyticus in only 5 out of 22 patients. The joints most commonly affected were those of the lower limbs and the symptoms were severe; in 2 out of 3 patients other joints were subsequently involved. Five patients had stable mitral regurgitation of undetermined duration, with systolic murmur. ECG abnormalities were noted in 7 patients, including 5 with prolongation of the PR interval and 2 with moderate elevation of the ST segment; these abnormalities regressed in all cases. No specific skin lesions were observed. The streptococcal infection was associated with a rise in antistreptolysins in 73% of the cases, a rise in antistreptokinases in 80% and a rise in both types of antibodies in 97%. Response to antibiotics and anti-inflammatory drugs was satisfactory in all cases. Cure was achieved within less than one month in 57% of the patients, but the condition lasted three years in 3 patients.

Streptococcal infection usually is defined as a positive throat culture with a serologic response to group A beta-hemolytic streptococci, and a patient with a positive throat culture and no serologic response is a streptococcal carrier. Studies suggest that streptococcal carriers should show little clinical response to antibiotic therapy when compared with patients with true streptococcal infections. Patients with acute pharyngitis were divided into three groups: group 1--38 patients with negative throat cultures; group 2--72 patients with a positive throat culture and a significant rise in streptococcal antibody titers; and group 3--77 patients with positive throat cultures and no significant rise in streptococcal antibody titers. Patients in group 2 and group 3 had a comparable and dramatic clinical response to antibiotic therapy that was considerably greater than the clinical response in the patients in group 1. These findings raise questions about the appropriateness of using streptococcal antibody responses to distinguish between the streptococcal carrier state and a true streptococcal infection.

The antidesoxyribonuclease B reaction shows in persons of all classes of age examined a similar distribution of titres as the antistreptolysin reaction. The anti DNase B titres however are mostly lower than the titres of the antistreptolysin reaction, except in the group of children, 6 to 17 years of age, suffering frequently from latent infections of streptococci. Women in childbed showed lower anti DNase B titres than other persons of corresponding age. Among persons with anti DNase B titres higher than antistreptolysin titres predominate men.

Serious errors may arise from misinterpretation of the Jones criteria for rheumatic fever. Many patients "fulfill" the criteria and yet have another disease. The danger in such cases is that the actual illness is not diagnosed and the patient is not treated for it. If salicylates or steroids are administered prematurely, ie, before the signs and symptoms of rheumatic fever are fully recognizable, a vague syndrome may develop and elicit an uncertain diagnosis and improper treatment.

The authors report two cases of Löfgren's syndrome, preceded by febrile polyarthritis with rise in antistreptolysin titer. The relationship between sarcoidosis and rheumatic fever is discussed. A review of the literature concerning Löfgren's syndrome with joint pain, permitted the authors to follow the course of present pathogenic concepts which haveled to the present opinion of the sarcoidosis nature of Löfgren's syndrome, when the latter is accompanied by erythema nodosum. The prolonged rise in antistreptolysin 0 titer which might suggest rheumatic fever, was not explained, but as the streptococcus was never found in throat swabs, it is probable that this was a non-specific phenomenon. However, certain authors believe that streptococcal infection, where it exists, may play a role, if not in the etiology of the sarcoidosis, at least in the Löfgren's syndrome which may lead to its discovery.

Sixteen healthy women showed a high variability of their titres in the antistreptolysin reaction, in the antideoxyribonuclease B reaction and in three different tests for determination of the rheumatoid factor during their cycles of menstruation. Two men of the same age had a similar behavoir. Therefore serologic results may be difficult to interpret.

Serological investigations in infections caused by hemolytic streptococci and by Yersinia enterocolitica (Y. ent.) can be diagnostically decisive. Here are presented the results of 2 extensive serologic investigations of a population of school children (n = 929) and of hospitalized patients (n = 2121). It is shown that only very high titers of streptococcal antibodies were of diagnostic value in single samples as most other titers had the same distribution and frequency in the healthy population. Titers of antibodies to Y. ent. were elevated 5 times more often in the hospital patients than in the healthy population. Antibodies to Y. ent. were approximately at the same level in all age groups in contrast to the streptococcal antibodies, which decreased with age. In about 4% of the 2121 patients investigated elevated antibody titers to both bacteria were found simultaneously. The differential diagnosis may be difficult in such cases especially if they exhibit symptoms of rheumatic fever.

A study was carried out to verify the clinical usefulness of the elaborated method for the measurement of antistreptococcal antibody in revealing the streptococcal etiology of glomerulonephritis. In 158 patients with glomerulonephritis antistreptococcal antibody (ASA), circulating immune complexes (CIC) and haemolytic activity of the complement were measured. On the basis of immune complex formation it has been concluded that streptococcal infection may cause glomerulonephritis. Serial determinations of ASA and CIC are helpful in establishing the streptococcal etiology of glomerulonephritis and in monitoring the course of the disease.

A review of the clinical and immunological features of 72 children with chronic arthritis revealed a similar pattern of disease in Australian children when compared with overseas studies. Most of the children had pauciarticular disease, but polyarthritis and systemic forms were seen. Although HLA=B27 was identified in some patients, no florid example of ankylosing spondylitis in childhood was seen. A small, but significant, number of children had evidence of potentially blinding iritis which developed insidiously, and one child had acute uveitis. Although elevated antistreptolysin-O titres and raised total IgM levels were seen in a significant number of children, they were not confined to any particular clinical pattern and were not of any major prognostic value. Half the children were severely incapacitated at the height of their disease, but follow-up for periods of up to five years revealed that fewer than 5% had a significant permanent disability.

Titers of antideoxyribonuclease-B (ADNB, by Streptonase-B test), antistreptolysin-O (ASO, by Rantz-Randall's micromethod) and Kinase test (antivaridase agglutination test) were performed on 118 sera of patients with suspected streptococcal infection and compared. Between ASO and ADNB, a fairly significant correlation was seen (r = 0.69), but many cases in which ADNB exceeded ASO were observed. Between Kinase and ADNB, no significant correlation was seen (r = 0.49). Successive determination of antibody titers were made in 14 consecutive patients with acute glomerulonephritis, anaphylactoid purpura nephritis, rheumatic fever and chronic rheumatic heart disease. In general, ADNB titer was significantly higher than ASO with few exceptions. The duration of high titer of ADNB was much longer than ASO Kinase titers were sometimes unstable. Throughout this study it has been noted that the result of ADNB was very easily to read and was highly reproducible. There were no nonspecific or pseudopositive reactions. Therefore, ADNB is useful for the diagnosis of streptococcal infection and its complication especially when other antibody titers give negative or doubtful results.

Exudate, adenopathy, and fever were used to predict clinically whether pharyngitis was streptococcal, nonstreptococcal, or questionable in 466 adults and 234 children. Clinical accuracy was: nonstreptococcal - adults 94.6 percent, children 86.9 percent; streptococcal - adults 44.2 percent, children 53.5 percent. Significance of results was determined by calculating the cost of routine cultures compared to risk of rheumatic fever. The economic justification of cultures was lowest in nonstreptococcal adults, streptococcal adults, and streptococcal children. Therapy of streptococcal patients presented an additional risk: anaphylaxis. The fatality risk after penicillin injection compared to the increased risk of rheumatic fever after oral penicillin is: adults 7.5 percent (clinical diagnosis), 3.3 percent (laboratory diagnosis); children 1.8 percent and 0.8 percent respectively. It is recommended that throat culture be obtained for all questionable patients and clinically nonstreptococcal children. Penicillin should be administered orally in the majority of adults.

The throat cultures were collected on swabs from total number of 3,599 of first grade children of elementary schools in Otsu City in 1978. Beta-hemolytic streptococci were isolated from 628 of 3,599 children (17.4%). Group A strains were found in 403 of 628 children (64.2%). Thus the frequency of recovery of group A streptococci from the children was 11.2% in this study. The size of tonsils in children with positive cultures for group A streptococci and negative response of ASO was larger than tonsils of children with negative cultures for group a strains and negative ASO response, and were smaller than the tonsils of children with positive cultures for group A strains and with positive ASO response. On the 20th day after oral administration of 400,000 units of penicillin derivative, group A strains were eradicated from throats in 76.2% of the treated children.

Immunological aspects of 40 northern Nigerian children with nephrotic syndrome of recent onset are reported. Eight our of 30 had hepatitis-associated antigen in their sera. Hypocomplementaemia was rare. Measurement of serum C3, C4, and ASOT was not of diagnostic value. Proteinuria selectivity index was poor in half of the patients, and appeared t o depend on the severity of the kidney lesion. Abnormal immunofluorescence of kidney glomeruli to immunoglobulins, complement, Plasmodium malariae, and Plasmodium falciparum was found in 26 of the 29 children. The pattern of immunofluorescence was chiefly granular and was confined to the glomeruli. IgM was predominant. It was concluded that immunological reaction is involved in the pathogenesis of nephrotic syndrome in northern Nigerian children.

The case is presented of a 27-year old male with typical Reiter's sundrome (RS) and cardiac lesions. Eight months after the initial onset of the joint and mucosal symptoms, atrial fibrillation and signs of cardiac failure suddenly supervened. Rheumatic fever, hyperthyroidism and myocardial infarction were ruled out. Digitalization and Valsalva maneuvers produced a return to normal sinus rhythm. At the same time a diastolic murmur was heard and the diastolic pressure fell to 40 mm Hg, suggesting acute aortic insufficiency. This carditis was attributed to RS. The evolution was favourable, although a mild degree of aortic insufficiency persisted.

Sequential serum samples obtained from 50 rheumatic fever subjects and from control individuals matched for time, age and geographical location were tested for antibodies against the M-associated protein antigens, MAP I and MAP II. Antibody titres were determined by the complement fixation test with a partially-purified extract of Streptococcus pyogenes serotype M30 as the MAP I antigen and an acid extract of serotype M48 as the MAP II antigen. Titres of MAP I antibody exceeded those of MAP II antibody in all but six rheumatic fever subjects. Anti-MAP I titres in excess of 40 were significantly more common in rheumatic fever subjects than in matched controls (p less than 0.001) or matched subjects with a diagnosis of acute post-streptococcal glomerulonephritis (p less than 0.01). Peak MAP I titres were present at the time of admission to hospital in the sera of 40 of the 50 rheumatic fever subjects. In the remainder peak titres occurred within 10 days. Antibody titres were maintained for a mean of 10.3 weeks before declining. Changes in MAP antibody titres were independent of changes in antistreptolysin O and anti-DNAase B titres. Normal children aged between 6 and 15 had higher MAP antibody titres than 2-5-year-old children. Rheumatic fever subjects had significantly higher mean titres of MAP I antibody than matched controls in each age group.

The Authors have carried out some experiences on four tests for the detection of anti O streptolysin, determining in 210 samples of sera: 1. the antistreptolysin titer according to Rantz and Randall; 2. the antistreptolysin titer according to the latex reaction; 3. five different antistreptococcal antibodies (ASO, ASK, ASHA, ADN-aseB, NAD-ase) with a rapid multi-purpose test for a simultaneous detection; 4. the antistreptolysin titer according to Aso Quantum method. The results obtained on the 210 samples of sera were compared. The relationship between the four methods were examined.

Prinqual, a new statistical data-analysis method was used to determine the critical titers of antistreptolysin O (ASLO), anti-DNase B (ADB) and antistreptokinase (ASK) in the sera of 104 patients with suspected streptococcal infection and 121 blood-donors. The whole range from pathological to normal was thus covered, thereby avoiding bias concerning the proportion of normal titers in a control population. Another advantage of the method was that the titers of the 3 antibodies were considered simultaneously and the semi-quantitative results of serological tests were avoided. It appeared from this study that the upper limits of normal values were: ASLO, 100 U; ADB, 240 U and ASK, 40 U. The first probably pathological values were: ASLO, 150 U; ADB, 480 U and ASK, 320 U. These results are compared with those available in the literature.

Antistreptolysin O level in blood serum is determined in double tests in 164 patients, 116 out of them with acute pneumonic processes. Antistreptolysin titre was established to be over 300 ASE in about 1/5 of the patients with acute focal pneumonias. In 10,4 per cent of the cases with acute pneumonic processes, an ascending dynamics of antistreptolysin O titre is observed in the course of the treatment and in 2,6 per cent the titre elevation is three and fourfold. In the interpretation of the data of the antistreptolysin titres in patients with acute focal pneumonia the possibility of oculte streptoccocal infection with another localization must not be neglected as well as pathological processes in liver parenchyma, leading to non-specific titre elevation.

An account is given of assessed titres of anti-streptolysin O (ASO) and antihyaluronidase (AH) in rheumatic fever, in rheumatic patients of inactive phase and in tonsillitis. The ASO titre was examined in 1739 members of the general public and in 360 patients with chronic rheumatic diseases. The author analyses 6235 examinations of ASO titres and 1210 AH examinations. In rheumatic fever the mean maximum ASO titre was 397 u, while the mean maximum AH titre was 3583 u. In inactive phase rheumatic patients the mean ASO titre was 187 u, the mean AH titre 630 u. The mean ASO titre at the onset of the disease in tonsillitis was 172 u. During the second examination after 3-4 weeks, the mean rise of the ASO titre was 205 u. A increased AH titre above 1280 u was recorded during the first examination in 35.2%, during the second examination in 52.3%. The mean ASO titre in the population group comprising 1739 subjects was 148 u. A titre increased above 200 u was recorded in 20.7%. The mean ASO titre in rheumatoid arthritis was 139 u, in ankylosing spondylitis 199 u, in systemic lupus erythematosus and diffuse scleroderma 128 u. In all groups the ASO and AH levels were inversely proportional to the age of the examined subject. Attention is drawn to the correct evaluation of the assessed antibody titres.