Q: I am 34 years old suffering from diabetes. Last year I took a blood test and the report showed my ASO > 800. My urine report showed a leukocyte esterase trace. What do these reports indicate? Am I suffering from some particular disease other than diabetes?

A:Rheumatic fever is a systemic disease that may occur following infection by a bacterium called group A beta haemolytic Streptococci. Anti-streptococcal antibodies are specific antibodies to streptococcal antigens (proteins) and indicate true infection with Streptococcus. High ASO titres have been reported to be associated with a variety of rheumatic syndromes. Streptococci produces haemolysins, which play an important role in tissue damage, one being Streptolysin O. This is highly immunogenic and evokes production of antibody to it called antistreptolysin O (ASO). Detection of this antibody in blood is useful in the diagnosis of recent infection. Other anti-streptococcal antibodies include anti-deoxyribonuclease B, anti-streptokinase, anti-hyaluronidase and anti-DNAase. ASO titres depend on the age of the patient and the local incidence of streptococcal infection. Levels higher than 200 IU/ml is usually taken as the upper limit of the normal range, since this value is rarely exceeded without symptoms indicative of streptococcal infection. The ASO level can be regarded as a measure of the extent and degree of infection. The levels (titres) of ASO reach the highest at the beginning of rheumatic fever, but they may also be seen in some other diseases like rheumatoid arthritis and Takayasu arthritis. Thus, rising titres of ASO have a greater significance and, in general, the antibodies rise during the first month after infection and then plateau for 3-6 months before returning to normal levels after 6-12 months. Leukocyte esterase is a urine screening test that detects a chemical which is found in the presence of white blood cells. The presence of these cells in the urine (above a certain limit) suggests a urinary tract infection. Please consult a physician who can examine you and interpret the reports in the light of your clinical findings.