Individuals with disease caused by S. pyogenes produce antibodies against various antigens. The most common are antistreptolysin O (ASO), anti-DNase B, antistreptokinase, and antihyaluronidase. Pharyngitis seems to be followed by rises in antibody titers against all antigens, whereas patients with pyoderma, an infection of the skin, only show a significant response to anti-DNase B. Use of serodiagnostic tests is most useful to demonstrate prior streptococcal infection in patients from whom group A Streptococcus has not been cultured but who present with sequelae suggestive of rheumatic fever or acute glo merulonephritis. Serum obtained as long as 2 months after infection usually demonstrates increased antibodies . As with other serologic tests, an increasing titer over time is most useful for diagnosing previous streptococcal infection.

Commercial products are available for detection of anti-streptococcal antibodies. Streptozyme (Alere Inc., Waltham, MA), which detects a mixture of antibodies, is a commonly used test. Unfortunately, no commercial system has been shown to accurately detect all streptococcal antibodies.

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