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Test ID: ADNAS Anti-DNase B Titer, Serum

Reporting Name

Anti-DNase B Titer, S

Useful For

Demonstration of acute or recent streptococcal infection using anti-DNase B titer

Clinical Information

A number of bacterial antigens have been identified in cultures of group A streptococci. These extracellular products are primarily enzymatic proteins and include streptolysin O, streptokinase, hyaluronidase, deoxyribonucleases (DNases A, B, C, and D), and nicotinamide adenine nucleotidase.

 

Infections by the group A streptococci are unique because they can be followed by the serious nonpurulent complications of rheumatic fever and glomerulonephritis. Recent information suggests that rheumatic fever is associated with infection by certain rheumatogenic serotypes (M1, M3, M5, M6, M18, and M19), while glomerulonephritis follows infection by nephritogenic serotypes (M2, M12, M49, M57, M59, and M60).

 

Glomerulonephritis and rheumatic fever occur following the infection, after a period of latency following the infection, during which the patient is asymptomatic. The latency period for glomerulonephritis is approximately 10 days, and for rheumatic fever the latency period is 20 days.

Interpretation

Elevated values are consistent with an antecedent infection by group A streptococci. Although the antistreptolysin O (ASO) test is quite reliable, performing the anti-DNase is justified for 2 primary reasons. First, the ASO response is not universal. Elevated ASO titers are found in the sera of about 85% of individuals with rheumatic fever; ASO titers remain normal in about 15% of individuals with the disease. The same holds true for other streptococcal antibody tests: a significant portion of individuals with normal antibody titers for 1 test will have elevated antibody titers for another test. Thus, the percentage of false-negatives can be reduced by performing 2 or more antibody tests. Second, skin infections, in contrast to throat infections, are associated with a poor ASO response. Patients with acute glomerulonephritis following skin infection (post-impetigo) have an attenuated immune response to streptolysin O. For such patients, performance of an alternative streptococcal antibody test, such as this assay, is recommended.

Analytic Time

Same day/1 day

Day(s) and Time(s) Performed

Monday through Friday; Continuously until 3 p.m.

Clinical Reference

Ayoub EM, Harden E: Immune response to streptococcal antigens: diagnostic methods. In Manual of Clinical and Laboratory Immunology. Fifth edition. Edited by NR Rose, EC de Marco, JD Folds, et al. Washington, DC, ASM Press, 1997

Method Name

Nephelometry

Specimen Type

Serum


Specimen Required


Patient Preparation: Fasting preferred but not required

Container/Tube:

Preferred: Red top

Acceptable: Serum gel

Specimen Volume: 1 mL


Specimen Minimum Volume

0.5 mL

Specimen Stability Information

Specimen Type Temperature Time Special Container
Serum Refrigerated (preferred) 28 days
  Frozen  28 days
  Ambient  7 days

Reference Values

<5 years: ≤250 U/mL

5-17 years ≤375 U/mL

≥18 years: ≤300 U/mL

Test Classification

This test has been cleared, approved or is exempt by the U.S. Food and Drug Administration and is used per manufacturer's instructions. Performance characteristics were verified by Mayo Clinic in a manner consistent with CLIA requirements.

CPT Code Information

86215

LOINC Code Information

Test ID Test Order Name Order LOINC Value
ADNAS Anti-DNase B Titer, S 5133-4

 

Result ID Test Result Name Result LOINC Value
ADNAS Anti-DNase B Titer, S 5133-4
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