Search

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.

In a test of the hypothesis that lysogeny of group A streptococci by a temperate bacteriophage might confer nephritogenicity, 283 sera from 69 patients were examined for IgG and IgM antibodies to M 49 streptococcal bacteriophage hyaluronidase. The IgG and IgM response to bacteriophage hyaluronidase was greatest in M 49 streptococci-infected individuals with nephritis, but M 49 streptococci-infected subjects without nephritis also had a greater immune response than did subjects infected with serotypes other than M 49. Although antibody to bacterial hyaluronidase was detected in all Streptococcus-infected groups, antibody to M 49 streptococcal bacteriophage hyaluronidase usually was found in only M 49 streptococci-infected patients. Although the greatest IgG and IgM antibody response to bacteriophage hyaluronidase can be demonstrated in individuals with glomerulonephritis, the antibody response does not indicate a direct relation of lysogeny and nephritis because subjects with and without nephritis after M 49 streptococcal infection all had a significant rise in antibody titer.

IgM and IgG type antibody titers and levels of serum IgG, IgA and IgM were determined in healthy young and aged subjects. The proportion of subjects of low antibacterial agglutinin titers progressively increased during the 7th and 8th decades of life. Anti-streptolysin-O titers were also shifted to the lower values in aged subjects, at least until the 8th decade of life, although subnormal values compared to the young control range were less frequent than in the case of IgM type antibodies. Anti-streptokinase values did not seem affected by age. In contrast to antibody levels, serum IgM was similar or slightly higher in old compared to young subjects. Evidence is presented that the proportion of 7 S IgM drops with aging. Both IgA and IgG levels increased through the 7th, 8th and 9th decades of life. Different class immunoglobulin levels seemed to be considerably correlated and a tendency to correlate was found between IgG type antibody and serum IgG levels. Complex investigations including quantitation of antibodies to extrinsic and intrinsic antigens and serum immunoglobulins are proposed to define the humoral immune status of aged subjects and to understand the causes as well as the diagnostic and prognostic significance of old age 'imbalances'.

We developed a liposome lysis assay for determining anti-streptolysin O antibodies (ASO) in human sera involving the use of carboxyfluorescein-entrapped multilamellar liposomes. This assay system was based on the inhibition of streptolysin O-induced liposome lysis by ASO. Briefly, after incubation of a given amount of streptolysin O with ASO for 30 min at 37 degrees C, carboxyfluorescein-entrapped liposomes composed of egg yolk phosphatidylcholine and cholesterol in a molar ratio of 1:1 were added to the mixture to determine the residual streptolysin O activity. Liposome lysis, detected as carboxyfluorescein release from the liposomes, was inversely proportional to the ASO titer. The results of within-run and between-run precision studies indicated that the liposome lysis assay is accurate and gives reproducible data. Bilirubin, hemoglobin, and triglycerides did not interfere with the liposome lysis assay. The ASO titers of 100 patient sera, evaluated by our new method and the Rantz-Randall method, showed good correlation.

Comparison of the serum titers obtained with the Streptozyme, the antistreptolysin O, the antideoxyribonuclease B, and the antistreptohyaluronidase tests suggested that the Streptozyme test had failed to detect antibodies against streptococcal deoxyribonuclease B and hyaluronidase. Moreover, sera that were negative in the Streptozyme test could be shown by immunodiffusion to possess significant numbers of precipitins against extracellular factors produced by group A streptococci. Follow-up studies on patients with diagnosed streptococcal infections revealed elevated antideoxyribonuclease and streptohyaluronidase titers and increased numbers of precipitation lines without simultaneous increased titers by the Streptozyme test. There is thus a need for stricter control of possible batch-to-batch variations and more careful standardization of the antigen content of the Streptozyme test.

A clinicopathologic study of 21 cases revealed pseudorheumatoid subcutaneous nodules occurring in the eyelids and periorbital region of children and young adults. These nodules were most frequently located in the lateral upper eyelids and outer canthal region, and in five cases they were multiple. The lesions recurred in about 20% of the cases. In addition, new lesions located elsewhere were observed in 26% of cases. Histopathologically they resembled the subcutaneous nodules of rheumatoid arthritis and rheumatic fever. Follow-up information on 15 patients (from two to 12 years) and the results of laboratory studies on seven patients had failed to reveal any association with these two systemic diseases. Pseudorheumatoid nodules may be indicated when a healthy child or a young adult presents with solitary or multiple subcutaneous nodules, especially in the eyelids. These lesions pursued a benign clinical course and local excision, which is usually performed for diagnostic purposes, was the only treatment indicated. The lesions had a tendency to regress spontaneously; therefore, local recurrences should be treated conservatively by periodic follow-up examinations.

The alteration of cellular reactivity was investigated in 20 patients with rheumatic fever at the first rheumatic attack or in relapse with confirmed heart damage. The results obtained by studying in parallel ESR, the ASLO titer, IDR to streptococci and the degree of leukocyte migration inhibition proved that the onset of rheumatic attack was preceded by a deep disturbance of the cellular immunity. The migration inhibition values were between 50 and 60% (as compared with 10% in the normal controls) in over 85% of the patients investigated. It is emphasized that the selection of cases of streptococcal angina should be made very carefully and that sometimes it is necessary to use a more specific method for the detection of rheumatic fever in its preclinical stage.

A new method is proposed for the determination of antistreptolysin O, based on the properties of streptolysin O. The reduced form of the toxin is hemolytic, whereas the oxidized form is not; this activity can be restored, however, by a reducing agent. Both forms maintain the capacity to bind specific antibodies. Unlike the classical method, the assay is performed on whole blood, using the patient's own erythrocytes as revealing agents. A procedure is proposed which limits the operation to a single dilution of a microvolume of blood (0.05 ml brought to 2 ml) and to the distribution of constant quantities in test tubes prefilled with different amounts of oxidized streptolysin O. After a few minutes, a reducing agent is added, and the reading is performed as in the classical technique after sedimentation of the erythrocytes. Correlation with the traditional method (r = 0.987) is evaluated on the basis of the results of samples from hospitalized patients.

The decline in incidence of rheumatic fever seen in many countries is not evident in New Zealand. Wairoa county has the highest hospital admission rate within New Zealand, 232 per 100 000 per year, five times the national average, 43 per 100 000. Studies in Wairoa included a cross-sectional survey of the local secondary school. Throat swabbing yielded 13.6% of subjects positive for beta-haemolytic streptococcus group A. Boys had a higher rate than girls, and girls aged 14 and over had a lower rate than younger girls. Discriminant analysis failed to identify ethnic, social or geographic factors as contributing to positivity. Sibling concordance was not significant. ASO titres were high in comparison with another New Zealand study (Rotorua Lakes). There was an association between high ASO titre and throat swab positive for group A and group C streptococci. The prevalence of definite rheumatic fever and rheumatic heart disease was established as 11/715 (1.5%). A wide range of residential geographic, climatic and socioeconomic factors failed to discriminate between cases and noncases. Ethnicity alone was a significant discriminator, the cases being more Maori than noncases.

Streptococcus pyogenes, group A, type 50, one of the few group A streptococcal types naturally occuring in mice, proved highly virulent in this species after experimental infection. Intranasal infection of 96 mice (Swiss albino, NMRI, and CBA) with this microorganism induced profound reactions in the cervical lymph nodes of 69% of the animals. Histologically, two different forms of reaction were distinguishable. In 61 mice, the lymph nodes exhibited follicular and lymphoplasmacellular hyperplasia and in 9 animals suppurative lymphadenitis was present. The ability of type 50 streptococci to persist in the pharynx of mice, and the similarity of the morphological changes induced by this organism appear to make intranasal murine group A, type 50, streptococcal infection a suitable model for human streptococcal pharyngitis.

This study evaluated the usefulness of determining antistreptolysin O(ASO) titers in filariasis. The ASO titers were elevated in most convalescence sera, but did not reflect comparable pathology resulting from dual Brugia-streptococcal infections in cats.

Hydroxyproline provable in the urine of man is regarded as indicator of the collagen metabolism. In 40 patients with ankylopoietic spondylarthritis the excretion of hydroxyproline in the 24-hour-urine was determined with the help of Stegemann's method. With 27.5 mg for the total hydroxyproline and 2.6 mg for the free hydroxyproline in the group of patients statistically significantly higher values were established than in a comparative group of 52 persons (20.1 or 0.6 mg, respectively). In patients with higher activity of the process (anamnestically, clinically) the excretions were larger than in patients with lower activity. That in this reflects also the temporary factor is to be concluded from the higher excretion rate in patients with a shorter duration of the disease and a low rate with a longer course. In comparison to the insignificant diagnostic relevancy of other acute-phase-reactions (BSR, CRP, number of leukozytes, blood protein fractions) from this results the conclusion that the determination of hydroxyproline may be used for the diagnostics of activity and also for the early diagnostics. By the temporary and technical-material expenditure, however, its use is limited in the routine practice.

Sera from patients with active and inactive rheumatic fever, as well as with other cardiac or lung diseases, were examined for the presence of rosette inhibition factors. In addition, the levels of antistreptolysin-O and of C-reactive protein activity were also determined. Sera from patients and dog alveolar macrophages were used as the in vitro system for the formation of rosettes. Aggregated normal human gammaglobulin was used as control. Inhibitory activity was present in 50, 71, 90 and 93% of the sera tested from patients with active rheumatic fever, inactive rheumatic fever, other cardiopathies, or pulmonary diseases, respectively. Sera from healthy individuals showed only 3% inhibitory activity and this, only at a very low titre. No correlation was found between the titre of inhibitory activity and either the levels of antistreptolysin-O or the presence of C-reactive protein. It was concluded that the rosette inhibition effect seems to be a nonspecific manifestation of cardiac or pulmonary diseases and to be unrelated to either etiology or pathogenesis of the diseases.

The question of whether hypersensitivity to streptococcal antigens plays a role in the pathogenesis of the nonsuppurative sequelae of streptococcal infections remains at present unclear. As a first step in the approach to this question, the degree of cellular reactivity of peripheral blood leucocytes to streptococcal antigens was investigated in a number of rheumatic fever patients, patients with uncomplicated streptococcal infections, as well as normal healthy subjects. Using the in vitro technique for the inhibition of capillary migration of peripheral blood leucocytes as an index of the degree of sensitivity to streptococcal antigens, the results indicate that patients with acute rheumatic fever exhibit an exaggerated cellular reactivity to these antigens and in particular to streptococcal cell membrane antigens. This abnormal response to streptococcal membrane antigens appears to persist in rheumatic subjects for at least 5 yr after the initial attack of rheumatic fever. Only Group A streptococcal membrane antigens elicited this unusual response in rheumatic subjects, since the cellular reactivity to Group C and D streptococcal membranes was the same in all groups. Patients with evidence of valvular disease exhibited the same degree of cellular reactivity to these antigens as did patients without clinical evidence of rheumatic heart disease. The nature of the antigens responsible for the observed cellular response remains unknown. Enzymatic treatment of streptococcal cell walls and membranes designed to remove type-specific M proteins did not alter the observed cellular reactivity to the streptococcal antigens. The finding that an abnormal cellular response to certain streptococcal antigens is present only in rheumatic patients suggests that cell-mediated factors may play an important role in the disease process.

A new case of myeloma with antistreptolysin O activity is described. The myeloma protein is Kappa IgG. By precipitation of this myeloma IgG with anti-Kappa antiserum, the antistreptolysin O activity is completely inhibited. For the antibody activities of the myeloma protein described in the litterature, the antistreptolysin O activity is the most frequently found. With this 19th case the authors discuss the fundamental problems of the antibody activities of myeloma protein.

In sera of patients with acute leucosis the authors have determined antibodies to alpha-toxin, streptolysin-O, the complement, lysosyme. B-lysins and C-reactive protein. It was found that the indices of immune reactivity in patients with acute leucosis are dependent on a morphological variant of the disease, the duration of the conducted therapy and presence of complications. The most high immunity indices in patients with acute leucosis were observed in a primary active stage of the disease and during the period of remission. Considerable reduction of the immunity was noted in the terminal stage of the disease.

Two hundred and ninety-four New Zealand secondary school students were examined by questionnaire, and physical and biochemical methods. The sample contained almost equal numbers of Maoris and Europeans. The findings related to joint conditions are presented. Past injury and rheumatic disease accounted for some of the reported morbidity, but no important sex or race differences in these factors emerged. There were, however, significant differences in serum uric acid levels with the Maori having higher levels than the Europeans. A significant correlation with body mass was present in both race and sex groups but a correlation with haemoglobin was present only in the European females. While hyperuricaemia was not associated with morbidity in this young sample, ethnic differences anticipated the higher prevalence of gout already observed in Maori men.

Serum concentrations of immunoglobulins A, M and G, of alpha 2-macroglobulin, complement component C 3 and of specific antibodies against streptolysin O, staphylolysin, influenza/parainfluenzavirus and measles virus were measured from 323 German and 167 alien pregnant women. Except from a statistically significant increase of IgG and alpha 2-macroglobulin in the alien group, no measurable differences could be seen. It is concluded that the evaluation of all measured parameters can be equal for both populations.

In clarification of the cause of Pustulosis palmaris et plantaris caused by tonsillar infection 19 patients with this condition and undergoing tonsillectomy were studied. IgE levels in the tonsils and blood serum were estimated both before and after tonsillectomy including various other laboratory tests. These results and the therapeutic effects of the tonsillectomy were analysed. 42 patients with tonsillitis undergoing tonsillectomy were used as controls. Lowered serum complement (C3) titres and decrease in neutrophil counts and serum IgG levels were observed in those patients whose cutaneous lesions were either completely or greatly improved following tonsillectomy. As neither the IgE levels in the tonsils nor in the serum were altered after tonsillectomy, the possibility of IgE mediated allergic type I reaction, as previously proposed by the present authors, was ruled out, and the aetiology was assessed to be an infectious allergy based on the Arthus reaction classified in the type III reaction.

In sera from 4 of 25,000 individuals tested for antibodies against streptococci, extremely high antideoxyribonuclease B titers ( > 10(6) U/ml) were found. Two of the cases were diagnosed as monoclonal gammopathies. The M-components were shown to possess the anti-deoxyribonuclease B activity. The other two cases were diagnosed as relapsing erysipelas. The high serum titers of deoxyribonuclease B antibodies were accompanied by a very inflammatory reactivity in the patients' sera and by an oligopolyclonal pattern of immunoglobulin G. In routine diagnoses of streptococcal infections with the anti-deoxyribonuclease B test, patients with extremely high serum titers should be examined for the possible occurrence of gammopathies.