Anti-streptolysin O

Anti-streptolysin O (ASO or ASLO) is the antibody made against streptolysin O, an immunogenic, oxygen-labile hemolytic exotoxin produced by most strains of group A and many strains of groups C and G bacteria. The "O" in the name stands for oxygen-labile; the other related toxin being oxygen-stable streptolysin-S. The main function of streptolysin O is to cause hemolysis (the breaking open of red blood cells) — in particular, beta-hemolysis.

Increased levels of aso titre in the blood could cause damage to the heart and joints. In most cases, penicillin is used to treat patients with increased levels of aso titre.

When the body is infected with streptococci, it produces antibodies against the various antigens that the streptococci produce. ASO is one such antibody. A raised or rising levels can indicate past or present infection. Historically it was one of the first bacterial markers used for diagnosis and follow up of rheumatic fever or scarlet fever. Its importance in this regard has not diminished.

Since these antibodies are produced as a delayed antibody reaction to the above-mentioned bacteria, there is no normal value. The presence of these antibodies indicates an exposure to these bacteria. However, as many people are exposed to these bacteria and remain asymptomatic, the mere presence of ASO does not indicate disease.

Acceptable values, where there is no clinical suspicion of rheumatism are as follows:

This titre has a significance only if it is greatly elevated (>200), or if a rise in titre can be demonstrated in paired blood samples taken days apart. The antibody levels begin to rise after 1 to 3 weeks of strep infection, peaks in 3 to 5 weeks and falls back to insignificant levels in 6 months. Values need to be correlated with a clinical diagnosis.

It is done by serological methods like latex agglutination or slide agglutination. ELISA may be performed to detect the exact titre value.

To detect the titre value, by a non-ELISA method, one has to perform the above agglutination using a serial dilution technique.

These antibodies produced against the bacteria cross-react with human antigens (mainly collagen) and hence attack the cellular matrix of various organs, mainly the heart, joints, skin, brain, etc.

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