Also Known As:
ADN-B
ADB
ADNase-B

Formal Name:
Antideoxyribonuclease-B Titer

This article was last modified on June 28, 2021

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Antistreptolysin O (ASO)

At a Glance

Why Get Tested?

To help determine whether you have had a recent strep infection with the bacteria group A Streptococcus; to help diagnose complications resulting from a recent strep infection, such as rheumatic fever or glomerulonephritis, a form of kidney disease

When To Get Tested?

When you have symptoms such as fever, chest pain, fatigue and shortness of breath that suggest rheumatic fever, or symptoms such as accumulation of fluid (edema) and dark urine that are associated with glomerulonephritis, especially when you recently may have had a group A streptococcal infection that was not diagnosed and treated appropriately; may be done along with or following an antistreptolysin O (ASO) test

Sample Required?

A blood sample drawn from a vein

Test Preparation Needed?

None

Looking For Test Results?

Looking For Reference Ranges?

You may be able to find your test results on your laboratory’s website or patient portal. However, you are currently at Testing.com. You may have been directed here by your lab’s website in order to provide you with background information about the test(s) you had performed. You will need to return to your lab’s website or portal, or contact your healthcare practitioner in order to obtain your test results.

Testing.com is an award-winning patient education website offering information on laboratory tests. The content on the site, which has been reviewed by laboratory scientists and other medical professionals, provides general explanations of what results might mean for each test listed on the site, such as what a high or low value might suggest to your healthcare practitioner about your health or medical condition.

The reference ranges for your tests can be found on your laboratory report. They are typically found to the right of your results.

If you do not have your lab report, consult your healthcare provider or the laboratory that performed the test(s) to obtain the reference range.

Laboratory test results are not meaningful by themselves. Their meaning comes from comparison to reference ranges. Reference ranges are the values expected for a healthy person. They are sometimes called “normal” values. By comparing your test results with reference values, you and your healthcare provider can see if any of your test results fall outside the range of expected values. Values that are outside expected ranges can provide clues to help identify possible conditions or diseases.

While accuracy of laboratory testing has significantly evolved over the past few decades, some lab-to-lab variability can occur due to differences in testing equipment, chemical reagents, and techniques. This is a reason why so few reference ranges are provided on this site. It is important to know that you must use the range supplied by the laboratory that performed your test to evaluate whether your results are “within normal limits.”

For more information, please read the article Reference Ranges and What They Mean.

What is being tested?

Anti-DNase B (antideoxyribonuclease-B antibody) is one of the most common of several antibodies that are produced by the body’s immune system in response to an infection with group A Streptococcus (strep infection). The anti-DNase B test measures the amount of this antibody in the blood. It is typically done with or following an antistreptolysin O (ASO) test, another test to detect antibody to a streptococcal antigen.

Group A Streptococcus (Streptococcus pyogenes), is the bacterium that causes strep throat and a variety of other infections, including skin infections (pyoderma, impetigo, cellulitis). In most cases, strep infections are diagnosed and successfully treated with antibiotics.

Sometimes a strep infection does not cause identifiable symptoms, goes untreated, or is treated ineffectively, and complications (sequelae), namely rheumatic fever and glomerulonephritis, can develop, especially in young children. These secondary conditions are uncommon in the U.S. because of routine strep testing and antibiotic treatment, but they do occur.

Rheumatic fever is a delayed immune response in which the body produces antibodies directed against itself (autoimmune). This can cause serious damage to heart valves and lead to symptoms such as swelling and pain in several joints, heart inflammation (carditis), skin nodules, rapid, jerky movements (Sydenham chorea), and skin rash.
Post-streptococcal glomerulonephritis, a condition affecting the kidneys, can develop a week or two after a strep infection. Your body produces antibodies to fight the strep infection, but these antibodies can eventually be deposited in the glomeruli, which are small, looping blood vessels within the kidneys that continually filter the blood. This can cause inflammation and kidney damage, affecting kidney function.

Common Questions

How is the test used?

The anti-DNase B test may be used to confirm that a recent strep infection with group A Streptococcus is the cause glomerulonephritis (a form of kidney disease) or rheumatic fever. The test may be used in conjunction with an ASO, another test used to detect prior strep infections.

Since complications resulting from strep infections have dropped in the U.S., so has use of the ASO test and anti-DNase B test.

When is it ordered?

The anti-DNase and ASO test are ordered when you have signs and symptoms that a health care practitioner suspects may be due to complications caused by a recent strep infection, including rheumatic fever and post-streptococcal glomerulonephritis.

Some signs and symptoms of rheumatic fever may include:

Fever
Joint swelling and pain in more than one joint, especially in the ankles, knees, elbows and wrists, sometimes moving from one joint to another
Small, painless nodules under the skin
Rapid, jerky movements (Sydenham chorea)
Skin rash
Sometimes the heart can become inflamed (carditis); this may not produce any symptoms but also may lead to shortness of breath, heart palpitations, or chest pain

Some signs and symptoms of glomerulonephritis may include:

Fatigue, decreased energy
Producing less urine
Bloody urine
Rash
Joint pain
Fluid accumulations and swelling (edema)
High blood pressure

However, these symptoms can be seen in other conditions.

Anti-DNase B testing may be performed twice, with samples collected about two weeks apart, for acute and convalescent titers. This is done to determine if the antibody level is rising, falling, or remaining the same.

What does the test result mean?

Anti-DNase B and ASO test results may be interpreted together. Anti-DNase B and ASO antibodies are produced about a week to a month after a strep infection. The amount of anti-DNase B antibody (titer) peaks about 4 to 6 weeks after the illness and may remain elevated for several months. They typically remain elevated longer than ASO antibody titers.

Negative anti-DNase B and ASO tests or very low titers means that it is unlikely you had a recent strep infection. This is especially true if a sample taken 10 to 14 days later is also negative. Your signs and symptoms are likely due to a cause other than a recent strep infection.

A small percentage (10-15%) of those who have a complication related to a recent strep infection will not have an elevated ASO titer. This is especially true with glomerulonephritis that develops after a skin strep infection. These people may, however, have an elevated anti-DNase B titer and/or an elevation in another streptococcal antibody such as an elevated antihyaluronidase titer.

Elevated or rising antibody titers of anti-DNase or ASO means that it is likely you had a recent strep infection.

If your have signs and symptoms of rheumatic fever or glomerulonephritis, an elevated anti-DNase B and/or ASO titer can help confirm the diagnosis.

Is there anything else I should know?

The anti-DNase B test may be ordered along with another streptococcal antibody test, such as an antihyaluronidase, especially if the ASO test is negative. A small percentage (10-15%) of people with a post-streptococcal complication will not have an elevated ASO but may have an elevated anti-DNase B or antihyaluronidase titer. This is especially true with glomerulonephritis linked to a recent skin strep infection.

Can an anti-DNase B or an ASO be used to diagnose strep throat?

No. A rapid strep test and/or throat culture are the best methods to diagnose strep throat. It is important that strep throat be promptly identified and treated to avoid complications and to avoid passing the infection on to others.

Can I develop rheumatic fever or glomerulonephritis at the same time as my strep throat?

These complications typically develop after the initial strep infection resolves. There is a delay when signs and symptoms appear after the streptococcal infection, about 1-2 weeks for glomerulonephritis and about 2-3 weeks for rheumatic fever.

If I am diagnosed with strep, will an anti-DNase B or ASO always be performed?

No. In general, these tests are only performed when you have symptoms suggesting that a complication may have developed after a group A strep infection that was not diagnosed and treated appropriately. Most people do not experience these complications, so these tests are not routinely done.

Like the rapid strep test, can the anti-DNase B test be performed in my doctor's office?

Most doctors’ offices will not perform this test, and some laboratories may not offer it. Your blood will typically be sent to a reference laboratory for testing.

View Sources

Sources Used in Current Review

(March 8, 2018) Mayo Clinic. Glomerulonephritis. Available online at https://www.mayoclinic.org/diseases-conditions/glomerulonephritis/symptoms-causes/syc-20355705. Accessed May 2019.

(November 17, 2017) Mayo Clinic. Rheumatic Fever. Available online at https://www.mayoclinic.org/diseases-conditions/rheumatic-fever/symptoms-causes/syc-20354588. Accessed May 2019.

Group A Streptococcal Disease. ARUP Consult©. Available online at https://arupconsult.com/content/streptococcal-disease-group. Accessed May 2019.

© 1995–2019 Mayo Foundation for Medical Education and Research. Anti-DNase B Titer, Serum. Available online at https://www.mayocliniclabs.com/test-catalog/Clinical+and+Interpretive/80204. Accessed May 2019.

Sources Used in Previous Reviews

(© 1995–2014). Anti-DNase B Titer, Serum. Mayo Clinic Mayo Medical Laboratories [On-line information]. Available online at http://www.mayomedicallaboratories.com/test-catalog/Overview/80204. Accessed January 2014.

Delgado, J. and Fisher, M. (Updated 2013 September). Streptococcal Disease, Group A – Group A, Strep. ARUP Consult [On-line information]. Available online at http://www.arupconsult.com/Topics/StrepA.html?client_ID=LTD. Accessed January 2014.

Robert J Meador, R. and Russell, I. J. (Updated 2013 December 13). Acute Rheumatic Fever. Medscape Reference [On-line information]. Available online at http://emedicine.medscape.com/article/333103-overview. Accessed January 2014.

Parmar, M. (Updated 2013 April 3). Acute Glomerulonephritis. Medscape Reference [On-line information]. Available online at http://emedicine.medscape.com/article/239278-overview. Accessed January 2014.

Khan, Z. and Salvaggio, M. (Updated 2013 September 30). Group A Streptococcal Infections. Medscape Reference [On-line information]. Available online at http://emedicine.medscape.com/article/228936-overview. Accessed January 2014.

Lewis, L. and Friedman, A. (Updated 2014 January 30). Impetigo. Medscape Reference [On-line information]. Available online at http://emedicine.medscape.com/article/965254-overview. Accessed January 2014.

Geetha, D. (Updated 2012 July 2). Poststreptococcal Glomerulonephritis. Medscape Reference [On-line information]. Available online at http://emedicine.medscape.com/article/240337-overview. Accessed February 2014.

Chin, T. et. al. (Updated 2012 May 30). Pediatric Rheumatic Heart Disease. Medscape Reference [On-line information]. Available online at http://emedicine.medscape.com/article/891897-overview. Accessed February 2014.

Salifu, M. and Delano, B. (Updated 2012 January 12). Diffuse Proliferative Glomerulonephritis. Medscape Reference [On-line information]. Available online at http://emedicine.medscape.com/article/239646-overview. Accessed February 2014.

Dugdale, D. (Updated 2011 June 9). Anti-DNase B. MedlinePlus Medical Encyclopedia [On-line information]. Available online at http://www.nlm.nih.gov/medlineplus/ency/article/003537.htm. Accessed January 2014.

Dugdale, D. (2011 September 20). Post-streptococcal glomerulonephritis (GN). MedlinePlus Medical Encyclopedia [On-line information]. Available online at http://www.nlm.nih.gov/medlineplus/ency/article/000503.htm. Accessed February 2014.

Chin, T. and Li, D. (Updated 2012 May 30). Pediatric Rheumatic Fever. Medscape Reference [On-line information]. Available online at http://reference.medscape.com/article/1007946-overview. Accessed February 2014.

Pessler, F and Sherry, D. (Modified 2012 February). Rheumatic Fever. Merck Manual for Healthcare Professionals [On-line information]. Available online through http://www.merckmanuals.com. Accessed January 2014.

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Anti-DNase B