Anti-DNase B Antibody Testing for Post-Streptococcal Complications

Primary Clinical Indications

The American Heart Association recommends anti-DNase B antibody testing to confirm recent or past Group A Streptococcal (GAS) infection, particularly when evaluating suspected post-streptococcal complications such as acute rheumatic fever or acute glomerulonephritis, in patients with a history of streptococcal infection 1
The European Society of Clinical Microbiology and Infectious Diseases suggests that the anti-DNase B test serves as a critical confirmatory tool for diagnosing post-streptococcal sequelae, not for diagnosing acute pharyngitis, in individuals with suspected post-streptococcal disease 2, 1

The American Academy of Pediatrics recommends confirmation of recent GAS infection in patients with suspected acute rheumatic fever or acute glomerulonephritis using anti-DNase B testing, which can remain elevated for several months after infection 1, 3
The Infectious Diseases Society of America suggests that anti-DNase B testing is particularly valuable as a secondary test when ASO is negative or equivocal, as anti-DNase B may remain elevated when ASO titers have normalized, in patients with a high clinical suspicion for post-streptococcal disease 1, 3
The American College of Cardiology recommends that anti-DNase B titers begin rising 1-2 weeks after GAS infection and peak at 6-8 weeks post-infection, making it a useful marker for detecting recent infections 1, 3

The American Heart Association recommends that ASO be used as the first-line test for suspected post-streptococcal complications, and anti-DNase B be ordered if ASO is not elevated but clinical suspicion remains high, in individuals with suspected post-streptococcal disease 1, 3
The European Society of Clinical Microbiology and Infectious Diseases suggests that combined ASO and anti-DNase B testing detects streptococcal infection in up to 98% of proven cases, making it a useful approach for maximizing diagnostic yield in patients with suspected post-streptococcal complications 1, 3

The American Academy of Pediatrics recommends that anti-DNase B testing cannot distinguish active infection from carrier state, and reflects past immunologic events only, in individuals with suspected post-streptococcal disease 1
The Infectious Diseases Society of America suggests that anti-DNase B testing is not recommended for routine diagnosis of acute pharyngitis, and serial testing is required for optimal interpretation, making it impractical for routine sore throat evaluation 2
The American College of Cardiology recommends that results must be interpreted with age-appropriate reference ranges to avoid false-positive interpretations, and newer latex agglutination and nephelometric assays may not be well-standardized against traditional neutralization assays 1, 3