Confirmed strep and titers?

[Bio and adopt]

My son had blood work done in Aug. his strep titers were normal. He had not had confirmed strep in awhile. In Sept. he had confirmed strep. How long should we wait to redo blood work? If his titers are still normal with confirmed case what does that mean?

[peglem]

If you already have confirmed strep, you don't need to run titers to confirm strep. If his titers are still normal, it just means he didn't produce an immune reaction to those 2 kinds of strep exotoxins- for whatever reason. Those titers can confirm a recent past strep infection, but they are not the antibodies that are involved in the PANDAS autoimmune reaction. When Swedo studied PANDAS, the subject criteria (which has sort of become dx criteria) was either a positive culture OR elevated ASO/antiDnase (to show a strep association in cases where infection was missed).

[Bio and adopt]

would a confirmed strep with no elevated titers help with insurance approval if we get to the point of needing IVIG? Does no elevated titers mean immune problem?

[peglem]

would a confirmed strep with no elevated titers help with insurance approval if we get to the point of needing IVIG? Does no elevated titers mean immune problem?

Not necessarily. There are many kids, both PANDAS and normal who do not get elevated ASO and AntiDnase titers, despite positive strep cultures. Mine for instance. An immunologist can run tests for immune deficiency.

 

Low ASO and AntiDnase are basically meaningless unless you've been tracking levels over time- then lowered levels would indicate that the infection has been overcome. Rising levels over time indicate an infection is not being eradicated.

 

Here is a link to Buster's FAQ about ASO and AntiDnase titers:

http://www.latitudes.org/forums/index.php?showtopic=3756&st=0#entry29305

Edited October 14, 2010 by peglem