Determinação do título superior de normalidade dos anticorpos anti-estreptolisina O (ASLO) para uma população de indivíduos sadios, entre 2 e 17 anos, residentes na cidade de São Paulo, Brasil
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Data
1997
Autores
Quaresma, Marina Rodrigues [UNIFESP]
Orientadores
Leser, Paulo Guilherme [UNIFESP]
Tipo
Tese de doutorado
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Introdução: A febre reumatica (FR) ainda e um problema de Saúde publica no Brasil. A deteccao de anticorpos anti-estreptolisina O (ASLO) no soro dos pacientes e importante no diagnostico e surtos de agudizacao da FR. Na literatura, o limite superior de normalidade dos anticorpos ASLO varia de acordo com a regiao do mundo. As diferencas climaticas e condicao socioeconomica de cada populacao impedem a adocao de um limite superior de normalidade universal para anticorpos ASLO. OBJETIVO: Determinar o limite superior de normalidade dos anticorpos ASLO em individuos osadioso, na faixa etaria de 2 a 17 anos, residentes na cidade de São Paulo-SP, Brasil. METODO: 484 criancas (sem sinais clinicos de infeccao estreptococica), entre 2 e 17 anos, foram consecutivamente selecionadas do Ambulatorio de Pediatria da UNIFESP (puericultura) e do Colegio da Policia Militar de São Paulo (1o. e 2o. graus). Secrecao da orofaringe para cultura e sangue foram colhidos em 2 ocasioes, com um intervalo de 1 mes. Individuos que apresentaram cultura positiva para estreptococo beta-hemolitico do grupo A (EBHA) foram excluidos. A deteccao de anticorpos ASLO foi realizada pela reacao de aglutinacao e a leitura realizada por 2 observadores independentes. Soros (colhidos nas 2 ocasioes) de 121 individuos, selecionados ao acaso, foram tambem testados pela reacao de neutralizacao. RESULTADOS: 379 completaram o estudo. 16 com cultura positiva para EBHA e 89 que nao retornaram para a 2ª visita, foram excluidos. A media de idade da amostra foi de 7,7 anos. 51,7% eram do sexo masculino, 71% frequentavam a escola ou creche e 36,5% dividiam o dormitorio com um numero superior a 2 individuos. O limite superior de normalidade dos anticorpos ASLO, correspondente ao percentil 97,5, foi de 320 UI. Os coeficientes intra-classe para determinar a reprodutibilidade do teste (resultado da 1a. e 2a. visitas lidos pelo mesmo observador) e entre-observadores (mesmo teste lido por 2 observadores independentes) foram de 0,789 (p < 0,001) e 0,98 (p < 0,001), respectivamente. Os coeficientes de correlacao entre as tecnicas (validade de criterio), para as amostras obtidas na 1ª e 2ª visitas foram de 0,69 (p < 0,05) e 0,77 (p < 0,05), respectivamente. CONCLUSAO:O limite superior de normalidade dos anticorpos ASLO para a populacao de São Paulo, Brasil e de 320 UI. A reacao de aglutinacao apresentou resultados validos (titulos comparaveis aos obtidos com o padrao ouro, a reacao de neutralizacao)
BACKGROUND: Rheumatic fever (RF) remains a public health problem in Brazil. The serologic detection of anti-streptolysin O antibodies (ASO) is important in RF diagnosis and disease activity. In the literature, the upper limit of ASO antibodies varies across world areas. Differences in social economic status and climatic conditions prevent the adoption of an universal upper limit for ASO antibodies. OBJETIVE: To determine the upper limit of normal ASO antibodies in “healthy” subjects, between the ages of 2 and 17, living in the city of Sao Paulo, Brazil. METHODS: 484 children (with no clinical signs of streptococcal infection) between the ages of 2 and 17, were consecutively selected from the pediatric preventive health care outpatient clinic of UNIFESP and also from a Military Police School (from kindergarten to high school age). Oralpharyngeal secretion for culture and blood were collected on 2 separate occasions, with an interval of 1 month. Patients presenting positive culture for group A betahemolytic streptococcus (GABHS) were excluded. The detection of ASO antibodies was carried out using the latex agglutination test and the result was rated by 2 independent observers. Sera (from the 2 occasions) from 121 subjects, randomly selected, were also submitted to the neutralization test. RESULTS: 379 completed the study. 16 with positive culture for GABHS and 89 who did not returned for the 2nd visit were excluded. The mean age of the sample was of 7.7 years. 51.7% were male, 71% were in school or daycare and 36.5% sharing the same bedroom with more than 2 subjects. The upper limit of ASO antibodies, corresponding to the 97.5 percentile, was 320 IU. The intraclass correlation coefficients calculated to determine the test-retest (result from 1st and 2nd visit read by the same observer) and inter-observer reliability (same test read by 2 independent observers), were 0.789 (p < 0.001) and 0.98 (p < 0.001), respectively. The Spearman correlation coefficients to compare both techniques (criterion validity) for the 1st and 2nd visits were 0.69 (p < 0.05) and 0.77 (p < 0.05), respectively. CONCLUSION: The upper limit of normal ASO antibodies for residents in the city of Sao Paulo, Brazil is 320 IU. The latex agglutination test presented a valid result (as comparared to the gold standard, the neutralization test).
BACKGROUND: Rheumatic fever (RF) remains a public health problem in Brazil. The serologic detection of anti-streptolysin O antibodies (ASO) is important in RF diagnosis and disease activity. In the literature, the upper limit of ASO antibodies varies across world areas. Differences in social economic status and climatic conditions prevent the adoption of an universal upper limit for ASO antibodies. OBJETIVE: To determine the upper limit of normal ASO antibodies in “healthy” subjects, between the ages of 2 and 17, living in the city of Sao Paulo, Brazil. METHODS: 484 children (with no clinical signs of streptococcal infection) between the ages of 2 and 17, were consecutively selected from the pediatric preventive health care outpatient clinic of UNIFESP and also from a Military Police School (from kindergarten to high school age). Oralpharyngeal secretion for culture and blood were collected on 2 separate occasions, with an interval of 1 month. Patients presenting positive culture for group A betahemolytic streptococcus (GABHS) were excluded. The detection of ASO antibodies was carried out using the latex agglutination test and the result was rated by 2 independent observers. Sera (from the 2 occasions) from 121 subjects, randomly selected, were also submitted to the neutralization test. RESULTS: 379 completed the study. 16 with positive culture for GABHS and 89 who did not returned for the 2nd visit were excluded. The mean age of the sample was of 7.7 years. 51.7% were male, 71% were in school or daycare and 36.5% sharing the same bedroom with more than 2 subjects. The upper limit of ASO antibodies, corresponding to the 97.5 percentile, was 320 IU. The intraclass correlation coefficients calculated to determine the test-retest (result from 1st and 2nd visit read by the same observer) and inter-observer reliability (same test read by 2 independent observers), were 0.789 (p < 0.001) and 0.98 (p < 0.001), respectively. The Spearman correlation coefficients to compare both techniques (criterion validity) for the 1st and 2nd visits were 0.69 (p < 0.05) and 0.77 (p < 0.05), respectively. CONCLUSION: The upper limit of normal ASO antibodies for residents in the city of Sao Paulo, Brazil is 320 IU. The latex agglutination test presented a valid result (as comparared to the gold standard, the neutralization test).
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QUARESMA, Marina Rodrigues. Determinação do título superior de normalidade dos anticorpos anti-estreptolisina O (ASLO) para uma população de indivíduos sadios, entre 2 e 17 anos, residentes na cidade de São Paulo, Brasil. 1997. 128 f. Tese (Doutorado em Ciências) - Escola Paulista de Medicina, Universidade Federal de São Paulo (UNIFESP), São Paulo, 1997.