THE STREPTOCOCCAL ANTIFIBRINOLYSIN TEST IN CLINICAL USE 1

Abstract

The streptococcal antifibrinolysin test of Tillett and Garner, which promised to be a practical method for diagnosing a recent hemolytic streptoeoccal infection, has subsequently been reported non-specific. Accordingly, a study was made of the trend of repeated tests in 15 normal infants and children, 6 healthy newborns, and 203 pediatric patients with various types of infection. Six types of trend were observed: (A) persistently negative tests (rapidly lysed clots); (B) early positive tests (resistant clots) becoming negative during convalescence; (C) early negative changing to positive with recovery; (D) persistently positive; (E) positive changing to negative and later becoming positive again; (F) negative to positive to negative tests (spiking). Trend A was universally present in the normal infants and children, in most mild non-streptococcal infections, and in some due to the hemolytic streptococcus. Trend B was frequently observed in severe non-streptococcal infections, and occasionally in a hemolytic streptococcal illness. Normal newborns also showed this trend. Trend C occurred in most hemolytic streptococcal diseases and was not seen otherwise. Trend D was found in rheumatic fever, acute hemorrhagic nephritis, and some hemolytic streptococcal infections. Trend E appeared when non-streptococcal infections were followed during convalescence by a streptococcal illness. Trend F was seen in one case of subacute bacterial endocarditis. This study suggests that the course of the antifibrinolysin test may be of diagnostic aid. The type of trend (Trend C) observed in the majority of patients with hemolytic streptococcal infections was found in no other type of infectious disease.