Suspension Anti-Streptolysin-O (ASO/ASL) Test

  • Rowa Yousef Alhabbab
Part of the Techniques in Life Science and Biomedicine for the Non-Expert book series (TLSBNE)


Group A streptococcus can cause several diseases that range from mild pharyngitis and impetigo to severe post-streptococcal sequelae. Group A streptococcus produces super-antigens such as streptolysin O (SLO). Group A streptococcus can activate the immune system to produce antibodies specific to SLO. Therefore, clinical laboratories confirm previous and existing group A streptococcus infections by detecting SLO-specific antibodies in patient’s serum. Here, the principle, applications, reagents, steps, and results interpretation process of the most commonly used test in clinical laboratories to detect SLO antibodies are explored.


GAS Streptococcus pyogenes Super-antigens Streptolysin O Anti-streptolysin O Latex agglutination 


  1. 1.
    Cole JN, Barnett TC, Nizet V, Walker MJ. Molecular insight into invasive group A streptococcal disease. Nat Rev Microbiol. 2011;9(10):724–36.CrossRefPubMedGoogle Scholar
  2. 2.
    Carapetis JR, Steer AC, Mulholland EK, Weber M. The global burden of group A streptococcal diseases. Lancet Infect Dis. 2005;5(11):685–94.CrossRefGoogle Scholar
  3. 3.
    Cunningham MW. Pathogenesis of group A streptococcal infections. Clin Microbiol Rev. 2000;13(3):470–511.CrossRefPubMedPubMedCentralGoogle Scholar
  4. 4.
    Fieber C, Kovarik P. Responses of innate immune cells to group A Streptococcus. Front Cell Infect Microbiol. 2014;4:140.CrossRefPubMedPubMedCentralGoogle Scholar
  5. 5.
    Goldmann O, Rohde M, Chhatwal GS, Medina E. Role of macrophages in host resistance to group A streptococci. Infect Immun. 2004;72(5):2956–63.CrossRefPubMedPubMedCentralGoogle Scholar
  6. 6.
    Loof TG, Rohde M, Chhatwal GS, Jung S, Medina E. The contribution of dendritic cells to host defenses against Streptococcus pyogenes. J Infect Dis. 2007;196(12):1794–803.CrossRefPubMedGoogle Scholar
  7. 7.
    Zinkernagel AS, Timmer AM, Pence MA, Locke JB, Buchanan JT, Turner CE, et al. The IL-8 protease SpyCEP/ScpC of group A Streptococcus promotes resistance to neutrophil killing. Cell Host Microbe. 2008;4(2):170–8.CrossRefPubMedPubMedCentralGoogle Scholar
  8. 8.
    Mishalian I, Ordan M, Peled A, Maly A, Eichenbaum MB, Ravins M, et al. Recruited macrophages control dissemination of group A Streptococcus from infected soft tissues. J Immunol. 2011;187(11):6022–31.CrossRefPubMedGoogle Scholar
  9. 9.
    Brosnahan AJ, Schlievert PM. Gram-positive bacterial superantigen outside-in signaling causes toxic shock syndrome. FEBS J. 2011;278(23):4649–67.CrossRefPubMedPubMedCentralGoogle Scholar
  10. 10.
    Bhakdi S, Tranum-Jensen J, Sziegoleit A. Mechanism of membrane damage by streptolysin-O. Infect Immun. 1985;47(1):52–60.PubMedPubMedCentralGoogle Scholar
  11. 11.
    Timmer AM, Timmer JC, Pence MA, Hsu LC, Ghochani M, Frey TG, et al. Streptolysin O promotes group A Streptococcus immune evasion by accelerated macrophage apoptosis. J Biol Chem. 2009;284(2):862–71.CrossRefPubMedPubMedCentralGoogle Scholar
  12. 12.
    Hakansson A, Bentley CC, Shakhnovic EA, Wessels MR. Cytolysin-dependent evasion of lysosomal killing. Proc Natl Acad Sci U S A. 2005;102(14):5192–7.CrossRefPubMedPubMedCentralGoogle Scholar
  13. 13.
    Nakagawa I, Amano A, Mizushima N, Yamamoto A, Yamaguchi H, Kamimoto T, et al. Autophagy defends cells against invading group A Streptococcus. Science. 2004;306(5698):1037–40.CrossRefPubMedGoogle Scholar
  14. 14.
    Zafindraibe NJ, Randriamanantany ZA, Rajaonatahina DH, Andriamahenina R, Rasamindrakotroka A. Current practice about the evaluation of antibody to streptolysin O (ASO) levels by physicians working in Antananarivo, Madagascar. Afr Health Sci. 2014;14(2):384–9.CrossRefPubMedPubMedCentralGoogle Scholar
  15. 15.
    Spectrum. Antistreptolysin O Titre (ASOT), s rspid lstex slide test for the detection of antistreptolysin O antibodies in serum. Spectrum-diagnostics. 2011. Available from: Accessed 7 September 2017
  16. 16.
    Archem diagnostic. Antistreptolysin O (ASO). falezmedkal. 2010. Available from: Accessed 7 September 2017

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  • Rowa Yousef Alhabbab
    • 1
  1. 1.Division of Applied Medical Sciences and Infectious Disease UnitKing Fahad Centre for Medical Research, King Abdulaziz UniversityJeddahSaudi Arabia

Personalised recommendations