Comparison of group A streptococcal titres in healthy children and those with pharyngitis and skin infections

Published:October 25, 2021DOI:https://doi.org/10.1016/j.jinf.2021.10.014

      Highlights

      • Healthy Māori and Pacific children had higher group a streptococcal (GAS) antibody titres than healthy European/Other children.
      • Children with GAS-positive sore throat had the highest anti-streptolysin O titres and children with GAS-positive skin infection had the highest anti-DNase-B titres.
      • Of children with GAS-positive sore throats, 62.1% had serological confirmation as defined by either a two-fold increase between acute and convalescent sera, or an ASO or ADB titre above the study calculated ULN.

      Abstract

      Objectives

      Rates of acute rheumatic fever, a sequelae of group A Streptococcal (GAS) infection, remain unacceptably high in Indigenous Māori and Pacific children in New Zealand. This prospective study aimed to describe GAS antibody titres in healthy children (5–14 years) by ethnicity, and to determine how paired titres vary with GAS culture positive and negative pharyngitis, and GAS skin infections.

      Methods

      Analysis included 887 children (32% Māori, 36% Pacific, 33% European/Other) from Auckland, New Zealand. Cases comprise 772 children who had a sore throat or skin infection, which resulted in a swab taken for culture. Healthy controls were asymptomatic (N = 154) and matched by age, ethnicity and region. All participants had a serum sample, with a second sample collected from cases only. Sera were analysed for anti-streptolysin O (ASO) and anti-DNase-B (ADB) antibodies.

      Results

      Healthy Māori and Pacific children had higher GAS antibody titres than healthy European/Other children. Children with GAS-positive sore throat had the highest mean ASO titres and children with GAS-positive skin infection had the highest mean ADB titres. When a two-fold increase or an upper limit of normal cut-off (ASO 450 IU/ml, ADB 400 U/ml) was applied to titres from children with GAS-positive sore throat, 62.1% were classified as having serologically confirmed GAS pharyngitis and 37.9% had GAS detected without serological response.

      Conclusions

      Elevated ASO titres were associated with GAS pharyngitis and elevated ADB titres were associated with GAS skin infections in New Zealand children. Higher ASO/ADB titres in healthy Māori and Pacific children could indicate a greater prior exposure to GAS infections.

      Keywords

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