c.

Glomerulonephritis
1) Symptoms: Proteinuria, hematuria, hypertension, impaired renal
function, and edema
2) Occurs about IO days after pharyngitis or 18-21 days after a skin
infection
3) Mechanism: Circulating antigen-antibody complexes are deposited on
the glomerular basement membranes, where complement is activated and damage to the
membranes results. Platelet aggregation and fibrin and fibrinogen build up, causing
capillary obstruction and impaired renal function.
B. DiagnosticTests
I. Cultureresultsyieldingbeta-hemolyticgroupAstreptococciaremostreliable; however,
the sequalae are immunologically mediated and do not involve actively growing
bacteria.
2. ASOneutralizationtest
a. Streptolysin O is a hemolysin produced by most beta-hemolytic group A
streptococci.
b. Infected individuals produce antibody to streptolysin 0.
c. TheclassicASOtestisaneutralizationassay.AntibodiestostreptolysinO
prevent hemolysis.
d. Serial dilutions of patient serum are prepared. The titer is the last tube with
no hemolysis. The result is expressed in Todd units, the reciprocal of the
original serum dilution (e.g., I :8 = 8 Todd units).
e. Interpretation:Afourfoldincreaseintiterbetweenacuteand
convalescent samples indicates a recent group A streptococcal infection.
f. The ASO neutralization test is rarely performed in the U.S.; it has been
replaced by other diagnostic methods.
3. ASOrapidlatexagglutinationtest
a. Principle: Latex particles coated with streptolysin O agglutinate when mixed
with patient's serum containing ASO antibody.
b. Interpretation: The following titers are considered indicative of a group A
streptococcus infection: preschool children >85, school-age children >170, and
adults >85.
4. Streptozyme
a. ScreeningtestproducedbyWampoleLaboratories(Cranbury,NewJersey)
that detects antibodies to five S. pyogenes proteins: DNase B,
hyaluronidase, NADase, streptokinase, and streptolysin 0
b. Principle: Streptozyme is a passive hemagglutination assay. Newer
methods use latex as the carrier particle. Immunonephelometry assays are
also available.
c. Interpretation: A fourfold rise in titer between acute and convalescent
sera is indicative of an infection.