Non-specific antistreptolysin reactions and serum or pleural-exudate cholesterol.

Hewitt and Todd (1939) occasionally noticed an obviously nonspecific increase in the antistreptolysin titer (AST) in sera that had been contaminated with certain bacteria. Independently, Lofgren (1944) has reported on the same phenomenon. In comprehensive AST studies on clinical material, Westergren several years ago paid attention to the common occurrence of unexpected rises in AST, often to exceedingly high levels, in sera from hepatitis patients. Kalbak (1947) has had similar experiences. Recently, Sievers (1947), as well as Westergren (1948), has compared the occurrence of these high titers with the results of various liver function tests. Systematic AST determinations in pleural exudates from patients treated at the Tuberculosis Department of St. G6ran's Hospital have shown a high rate of elevated titers, often above 1,000, and not infrequently above 10,000, units in patients whose serum titers were normal or only moderately increased. In most of these cases no definite connection with streptococcal infections could be demonstrated. When the conditions responsible for these apparently nonspecific AST reactions were studied, it was found that sera and exudates when treated with acid or alkali (and subsequently neutralized) showed striking increases in AST (tables 1 and 6). At the first glance it seemed very unlikely that, in these four instances of nonspecific antistreptolysin reactions-viz., (1) sera (exudates) contaminated with certain bacteria, (2) a great number of hepatitis sera, (3) pleural exudates, and (4) acidor alkali-treated sera (exudates)-there could possibly be a common causative factor. Yet from a biological point of view it would be far more logical if those findings were attributable to one and the same basic mechanism. In the present paper a report is given on a series of experiments conducted in order to arrive at a uniform explanation of the foregoing nonspecific increases in the antistreptolysin titer. For a better understanding of the problems involved an outline of the mechanism of the streptolysin 0 hemolysis will have to be drawn according to our