ASO Titers results

[momof3inTN]

So when we were at the doctor the other day for joint pain I asked him to run ASO titers on my ds. He had a strep infection about 3 weeks ago, his results were 7. I expected them to be high, am I wrong? Since his titers are low after a confirmed strep infection what else should I be looking into? The doctor said the joint pain is from Osgood Disease, which is when the bones grow faster than is tendons.

 

Should I try to find a doctor to run a full immune panel?

 

Thanks

[JAG10]

Hi~children with PANDAS can have irregular immune markers (mine had low IgA, IgG and no response to strep pneum or Influen vaccines), but a low or no ASO response doesn't necessarily mean an across the board hypo immune response. My dd11 had very high ASO and Anti DNAse B titers (but never swabbed or cultured positive-ever), but many immune markers were low.

 

It just seems to me after reading these posts for a year kids either swab/culture positive consistently and don't have the elevated titer response OR never swab positive and have highly elevated titers. I'm sure there are some out there that have both...which would be normal:swab positive followed by a titer rise the appropriate number of weeks later. But that is kinda the hallmark of a PANDAS kid...not much turns out the way it is supposed to.

 

As far as running bloodwork on the immune system, if you have a PANDAS knowledgeable, friendly doctor that is also an immunologist or related MD, sure. Just know who you are dealing with ahead of time because if the doctor is unconvinced or confused about PANDAS, it could be a frustrating experience for you. There are docs out there, claiming to be PANDAS knowledgeable, who will say "No titer response, no PANDAS!" This is absolutely not true. You can find many threads on this board loaded with kids with no titer response-LOADED!

 

If you find a immune doc open to learning and helping you, they could contact Dr. B for consultation.

 

Best Wishes!

[airial95]

My child has never had elevated titers - even with positive throat cultures.

[amyjoy]

the typical strep "titers" (ASO / anti-dnase are antibody titers, the level of the body response to the strep, not the actual level of strep in the body. so those can be confusing, because like jag10 said above, there can be reasons the body cannot mount a response to the strep. Maybe the immune system has a primary immune deficiency, or has become weakened due to other infections or immune issues (in my son's case it was probably due to the severe celiac which is also autoimmune). So you can have a negative ASO titer. Is that the only symptom he has, joint pain?

 

it wouldn't hurt anyone to do a trial of antibiotics if you sincerely suspect strep, while looking at other immune markers.

 

just fyi, not that this necessarily relates to you, but at age 7 my son developed severe heel pain, and leg pain, which the osteo dr insisted was the osgood syndrome. it was very painful and limiting for several year, until about a year ago when we finally discovered he has celiac and went off of gluten - 2 weeks later he was literally 100% pain free for the first time he could even remember (he was 13 when we discovered the celiac and the pandas as well). My point is that, doctors are not always right about such things.

 

If you have an intuitive sense, follow it through.

Good luck with that.

amy