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My son (12) was diagnosed with PANDAS this time last year. He has been on antibiotics. His ASO titer has gone slowly form 577 to 396, however his AntiDNase B titer is strange. After 6 tests this year (bi-monthly) he either is exactly at 480 or 340. When it's 480 he is symptomatic, at 340 he is pretty good.


Why will the AntiDnase B titer not go down beyond 340????


Has anyone every experienced this???


Thank you.

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An elevated anti-strep titer such as an ASO or DNAse-B Antibody means the child has had a strep infection sometime within the past few months, and his body created antibodies to fight the strep. bacteria. Some children create lots of antibodies and have very high titers (up to 2,000), while others have more modest elevations. The height of the titer elevation doesn’t matter. Further, elevated titers are not a bad thing. They are measuring a normal, healthy response – the production of antibodies to fight off an infection. The antibodies stay in the body for some time after the infection is gone, but the amount of time that the antibodies persist varies greatly between different individuals. Some children have "positive" antibody titers for many months after a single infection.


The lab at NIH considers strep. titers between 0-400 to be normal. Other labs set the upper limit at 150 or 200. Since each lab measures titers in different ways, it is important to know the range used by the laboratory where the test was done – just ask where they draw the line between negative or positive titers.


It is important to note that some grade-school aged children have chronically “elevated†titers. These may actually be in the normal range for that child, as there is a lot of individual variability in titer values. Because of this variability, doctors will often draw a titer when the child is sick, or shortly thereafter, and then draw another titer several weeks later to see if the titer is “rising†– if so, this is strong evidence that the illness was due to strep. (Of course, a less expensive way to make this determination is to take a throat culture at the time that the child is ill.)


Some basic info about the blood tests for strep


Streptozyme: Detection of multiple antibodies to extracellular antigens of streptococcus. While the streptozyme is of some diagnostic value it should never replace more standard tests such as streptolysin O antibody (ASO) or DNase-B antibody. These antibodies may be detected in patients after streptococcal pharyngitis, rheumatic fever, pyoderma, glomerulonephritis, and other related conditions. In evaluating a patient with suspected acute rheuamtic fever or nephritis, determination of ASO, DNase-B antibody, and streptozyme will likely yeild a postive reult in 92-98% of cases.


Streptolysin O Antibody (ASO): The ASO test is used to provide serologic evidence of previous group A streptococcal infection in patients suspected of havinga non-suppurative complications, such as acute glomerulonephritis or acute rheumatic fever. Use of the ASO for diagnosis of an acute group A streptococcal infection is rarely indicated unless the patient has received antibiotics that would render the culture negative. An ASO performed on serum obtained during the presentation of a non-suppurative complication that shows a titer two dilutions above the upper limit of normal is evidence for an antecedent streptococcal infection. It is recommended, however, to use a second test such as the anti-DNAse B to confirm antecedent infections. Elevated serum ASO titers are found in about 85% of individuals with rheumatic fever. When both ASO and anti-DNAse are used, the result is over 95%. Skin infecitons with group A streptococci are often associated with a poor ASO response.


Reference Interval: (varies depending on the lab)

0-1 year: 0-200 IU/Ml

2-12 years: 0-240 IU/Ml

>13 years: 0-330 IU/Ml


DNAse-B Antibody: the majority of group A streptococci produce significant quantities of DNAse-B, while most other groups of streptococci do not. High levels of neutralizing antibody to DNAse-B are commonly found in patients following a group A streptococcal infection. Since it persists longer than other streptococcal antibodies (2-3 months), it is the preferred test in patients with chorea suspected due to rheumatic fever. Since it is not influenced by the site of infection, DNAse-B antibody is more reliable than the ASO test in providing evidence for streptococcal infection in patients with post-impetigo glomerularnephritis. Elevated titers are strongly suggestive of recent or current infection with group A streptococci. Fourfold increases in titers between acute and covalescent samples tken approximately 2 weeks apart are confirmatory.

Reference Interval: (varies depending on the lab)


1-6 years: <1:60

7-17 years: <1:170

18 years and over: <1:85


So these are the "tests" for PANDAS which you will read about when researching PANDAS which are not actually tests confirmaing PANDAS but rather the presence of streptococci infection in association with the onset of neuropsychiatric symptoms in a child.


Because your son is a bit older his titers are for the most part in the normal range.


Personally, I have not had a titer drawn on my son in just about two years although he has had probably about 3-4 "PANDAS" outbreaks...we did have throat swabs done and he was started on antibiotics each time and the tics etc resolved. I prefer to focus on symptoms rather than rely on the #'s with the blood tests.

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No, sorry, I will let the PANDAS experts comment there.


But I would encourage you to investigate a possible zinc deficiency. Zinc is critical in fighting infections.


Are you giving him probiotic 2 hours after the antibiotic to prevent yeast issues?



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Yes he is getting the probiotic, as well as a one-a-day.


We had struggled for 5 years with a diagnosis of ADHD. Unfortunally I medicated my son and the stimulants lead to much more movement. This time last year he got the FLU and all ###### broke loose, night terrors, picking his face, uncontrolled movements etc. We went to A.I.Dupont, the doctor read all the "evaluations" done on my son, did a complete family history ( I had rhematic fever/chorea ). They did the blood work and his titers were elevated. My son is much better. I can "see" the illness before it shows itself. He gets emotional and I just know he will be ill soon. I have charted his symptoms for a year.


Perhaps 340 is a normal range for my son's antiDNase B titer? The ASO is going down slowly.


He has not had a strep in over a year, yet his titers are still elevated.

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Thanks Ronna for the info...seems like Mommy007 and I were posting similar questions at the same time! So I imagine in my case your advise would be the same as my doctors and my thoughts on this, that we should just watch him and see if there are any increases in tics or behaviour changes or complaints about his throat. If so that we get a throat culture. My doctor is not big on lots of blood work, this is the first re-testing since August and it was only done since we were drawing blood for the food sensitivity testing. My son continues to do so well, we are thrilled.




PS - How long was your son on prophylactic antibiotics in total. I am amazed that I am at the point where I am considering when to stop the antibiotics, I never thought I would feel so confident. I think we will first get through the winter season but I hope by spring we can give it a try.


PPS - Hope you and baby are keeping well!


Question for Mommy007 - how long has your son been on prophylactic antibiotics? What are his tics currently like, or like in general? What are your plans with respect to the antibiotics?

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Allison, Kurt was on prophylactic antibiotics for a year. Treating as needed is working well for us now. I had him on vitamins and had eliminated milk, chocolate, eggs and corn for about 4 months before we stopped the antibiotics. We then treated for yeast and used probiotics.


It was was a long road but now things are so much easier.


The baby and I are doing fine :( I am 15-16 weeks and hoping time goes fast.



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My son has been on antibiotics and probiotics for a year now. His tic's are gone! He also had OCD - gone! They only appear if and when he gets sick.


The last time he was ill - fever etc, he starting ticking, stammering, hyper movements etc - I charted the symptoms and worked with the teachers - it only took 11 days for the major symptoms to go away - record breaking time for him.


I was on antibiotics when I was 7 until 18 years old - I can still take the same antibiotic - which I have to take when I see a dentist. I never took probiotics as a kid.


My intention is to continue the antibiotic/probiotics for now. I have not thought of stopping - I can't imagine going back to the way it was.


He is still a bit symptomatic, mostly movements, tapping feet, his current teachers are wonderful. He just turned 12 - I am hopeful that in the next few years his body will work this out. It did for me.


We have a 6month appt. at Dupont to follow up with his PANDAS. I will see what the doctor thinks about his titers. The ASO has taken a year to go from 577 to 396 - he did not have any strep within the year. I know his titers have been elevated for years - as one behaviorial pediatrician did an ASO count in 4th grade, it was 480 - the doctor mentioned PANDAS - but assumed my son had a strep in the previous weeks - I told him he did not but . .


He was finally diagnosed and treated at the end of 5th grade. Taking him off stimulants was the best thing. They only increased the OCS/Tics - to an extream!


The FLU last year, as bad as it was (night terrors) was probably the best thing that happened - it took us in the right direction!


The night terrors lasted about 6 months - once his ASO went down in the 400's they stopped - but that was the worst experience in the world.


My school district had never heard of PANDAS, just recently I spoke to a school counselor - who sought me out - he daughter has PANDAS - now two children have the diagnosis

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Hi Mommy007,


Thanks for the info, it is always great to hear a success story with PANDAS. We actually think my older brother had it as a child, although not as extreme as my son, and he was never taken to the doctor for any symptoms. He blinked and rolled his eyes for more than a year - might have been a few years - no one really remembers. It did not effect him socially, he was very athletic and very social, very much like my son. I still am amazed that my son has functioned as well as he has over the last 4 months, all while also starting grade one. When my brother read the info on PANDAS he felt he fit the bill, especially stuff related to school and learning. He has absolutely no tics now. He thinks they started at 8 and lasted a year or so, my mother thinks it started a bit later. Amazing how we forget things as time goes by.


Did you post as Deb on another site??

I am sure in my reading posts at some point there was another Mommy07 or it may have been mommy03? Anyway there was a Deb who had a positive outcome that she shared and gave me lots of hope.



Have you ever had to treat for a strep infection since being on the prophylactic?

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  • 1 year later...
  • 2 years later...
  • 4 years later...

Need help in understanding test results. My 14 year old son has been having physical and psychiatric symptoms for 2 years. He suffered severe pain in his thigh to the point that he was screaming in pain for a week. After no conclusive issues he was diagnosed with complex regional pain syndrome. He received therapy and the pain has eventually gone away, but behavioral symptoms have continued.


In a search for answers, his psychiatrist recently tested him for strep titters. His ASO was negative but his anti DNase level was 980. He has not had a strep infection since right before his leg pain started 2 years ago. He has had strep throat swabs as recently as a month ago, all of which have been negative. He does not have any OCD symptoms and only had a tic briefly after his leg pain issues.


Trying to decide how to move forward. Not sure what type of doctor to even consult.


Any suggestions are appreciated.

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Some kids have elevated dnase antibodies for a very long time. Every child is different but it is most helpful to track these titres over time to confirm that they are going up or down. Do you have any results to compare to? It's important that ASO are normal as that is indicative of no current infection.


Here I am answering all if these questions, yet I posted a question myself to the opposite effect and so far no one has answered. My son has high ASO titres 8 weeks into abx but no dnase at all. I'm so confused. My PCP is putting a call in to infectious disease doc for advice, which is what is recommend you do if you need clarification. My fear is my kiddo doesn't make the dnase antibody at all or still has a chronic infection. We will be following titres every 2to4 weeks until we see some numbers budging.


Hope that was somewhat helpful, even though we are in opposite boats.

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I forgot to mention that commonly a swab or culture will give false neg results while a child is in abx. The bacteria can hide deep in the tissues during treatment and not be captured in the swab. This is evident when PANDAS kids have their tonsils removed and culture comes back pos even after intensive abx and many neg swabs. The titres are a better way to be sure if what is going on in immune system but again, kids can vary in their own personal normal range and patterns during and post infection which is shy testing over time is so important.

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